Management of Bipolar Disorder During Pregnancy The Postpartum Period

Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care

“…Among AD, SSRIs and, possibly, serotonin and noradrenaline reuptake inhibitors (SNRIs) have been associated with preterm labor, respiratory distress, serotonin rebound syndrome, pulmonary hypertension and feeding problems in the neonate 557,558,559. Furthermore, a number of mood stabilizers have been associated with fetal malformations, including carbamazepine and valproate 560,561. Current evidence seems to suggest that Fallot's tetralogy is not considerably elevated with lithium compared to the rate in the general population 560.…”

“…Furthermore, a number of mood stabilizers have been associated with fetal malformations, including carbamazepine and valproate 560,561. Current evidence seems to suggest that Fallot's tetralogy is not considerably elevated with lithium compared to the rate in the general population 560.…”

Gender differences in thyroid system function: relevance to bipolar disorder and its treatment

“…The progression in female reproductive stages over a lifetime may be associated with an exacerbation of bipolar disorder and a decrease in mood elevation . Treatment of bipolar disorder during pregnancy and lactation is particularly challenging as mood stabilizers may be a potential risk to the developing fetus and infant, and there is a high risk of recurrence in the postpartum period .…”

Considerations in the management of bipolar disorder in women

“…Valproate has been associated with possible mental retardation as part of the ‘fetal valproate syndrome’. Carbamazepine has been associated with transient hepatic toxicity hepatitis and direct hyperbilirubinemia [62]. These complications may even occur after exposure, late in pregnancy [65].…”

“…The dilemma all clinicians face is the task of minimizing potential risks to the fetus (by choosing whether or not to continue psychotropic medications), while at the same time optimizing the mental health of the mother and not exposing her to risk of relapse by ceasing medication prematurely. Rather than following set guidelines, several authors [62,88] have proposed an individualized approach, which base decisions on treatment on the severity of illness, prior frequency of episodes and any past history of relapse in pregnancy and the post‐partum period. It is now known that abrupt discontinuation of medication should be avoided because of the increased risk of sudden relapse [88].…”