Managing Bipolar Disorder during Pregnancy: Weighing the Risks and Benefits

Viguera, Adele C.; Cohen, Lee S.; Baldessarini, Ross J.; Nonacs, Ruta

doi:10.1177/070674370204700503

Cited by 102 publications

(105 citation statements)

References 102 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…44 For those who do receive treatment, health providers must assess any fetal risk associated with mood stabilizing drugs. 46,47,50 The 12-month prevalence of anxiety disorders (13.2%) in this study was similar to the rates reported in the literature for pregnant women. 19,25,21 Few studies have investigated the prevalence of PTSD in pregnancy, particularly among economically disadvantaged and ethnically diverse women.…”

Section: Discussionsupporting

confidence: 89%

“…45 From a clinical perspective, there is an elevated risk of relapse and hospitalization for bipolar I disorder during pregnancy, 46 as well as an added risk when moodstabilizing drugs are withdrawn abruptly. 47 Bipolar disorders can be undiagnosed or misdiagnosed as unipolar depression, with the inappropriate use of antidepressant monotherapy. 48 Sharma and colleagues report that more than one third of 61 cases identified as treatment-resistant depression actually were bipolar.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Psychiatric Disorders and Treatment in Low-Income Pregnant Women

Cook

Flick

Homan

et al. 2010

Journal of Women's Health

View full text Add to dashboard Cite

Aims: This study estimated the prevalence of twenty-two 12-month and lifetime psychiatric disorders in a sample of 744 low-income pregnant women and the frequency that women with psychiatric disorders received treatment. Method: To identify psychiatric disorders, the Diagnostic Interview Schedule (DIS) was administered to Medicaid or Medicaid-eligible pregnant women enrolled in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). The sample was stratified by the rural or urban location of the WIC sites in southeastern Missouri and the city of St. Louis. Eligible women were enrolled at each site until their numbers were proportional to the racial distribution of African American and Caucasian pregnant women served there. Results: The 12-month prevalence of one or more psychiatric disorders was 30.9%. Most common were affective disorders (13.6%), particularly major depressive disorder (8.2%) and bipolar I disorder (5.2%). Only 24.3% of those with a psychiatric disorder reported that they received treatment in the past year. Lifetime prevalence of at least one disorder was 45.6%, with affective disorders being the most frequent (23.5%). Caucasian women were more likely than African Americans to have at least one 12-month disorder, with the difference largely accounted for by nicotine dependence. Higher prevalence of lifetime disorders was also found in Caucasian women, particularly affective disorders and substance use disorders. There were no differences in the prevalence of 12-month or lifetime psychiatric disorders by the urban or rural residence of subjects. Conclusions: With nearly one third of pregnant women meeting criteria for a 12-month psychiatric disorder and only one fourth receiving any type of mental health treatment, comprehensive psychiatric screening during pregnancy is needed along with appropriate treatment.

show abstract

Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Psychiatric Disorders and Treatment in Low-Income Pregnant Women

Cook

Flick

Homan

et al. 2010

Journal of Women's Health

View full text Add to dashboard Cite

show abstract

“…3,7 The results of prior meta-analyses have been conflicting. Several have found no evidence of increased risk of major congenital malformations above the baseline [8][9][10] rate, which has been widely cited as 1%-3% for any pregnancy in North America [11][12][13][14] and less than 4% for minor congenital malformations. 15 The most recent meta-analyses did report an increased risk for congenital malformations 16 and cardiac malformations 13,16 with paroxetine exposure specifically.…”

mentioning

confidence: 99%

Antidepressant Exposure During Pregnancy and Congenital Malformations: Is There an Association?

Grigoriadis¹,

VonderPorten²,

Mamisashvili³

et al. 2013

J. Clin. Psychiatry

155

117

View full text Add to dashboard Cite

Objective: Depression is often not optimally treated during pregnancy, partially because of conflicting data regarding antidepressant medication risk. This meta-analysis was conducted to determine whether antenatal antidepressant exposure is associated with congenital malformations and to assess the effect of known methodological limitations. Data Sources: EMBASE, CINAHL, PsycINFO, and MEDLINE were searched from their start dates to June 2010. Keywords of various combinations were used, including, but not limited to depressive/mood disorder, pregnancy, antidepressant drug/agent, congenital malformation, and cardiac malformation. Study Selection: English language studies reporting congenital malformations associated with antidepressants were included. Of 3,074 abstracts reviewed, 735 studies were retrieved and 27 studies were included. Data Extraction: Two reviewers working independently assessed article quality. Data on use of any antidepressant, including fluoxetine and paroxetine specifically, were extracted. Outcomes included congenital malformations, major congenital malformations, cardiovascular defects, septal heart defects (ventral septal defects and atrial septal defects), and ventral septal defects only. Results: Nineteen studies were above quality threshold and make up the primary meta-analyses. Pooled relative risks (RRs) were derived by using random-effects methods. Antidepressant exposure was not associated with congenital malformations (RR = 0.93; 95% CI, 0.85-1.02; P = .113) or major malformations (RR = 1.07; 95% CI, 0.99-1.17; P = .095). However, increased risk for cardiovascular malformations (RR = 1.36; 95% CI, 1.08-1.71; P = .008) and septal heart defects (RR = 1.40; 95% CI, 1.10-1.77; P = .005) were found; the RR for ventral septal defects was similar to septal defects, although not significant (RR = 1.54; 95% CI, 0.71-3.33; P = .274). Pooled effects were significant for paroxetine and cardiovascular malformations (RR = 1.43; 95% CI, 1.08-1.88; P = .012). These results are contrasted with those addressing methodological limitations but are typically consistent. Conclusions: Overall, antidepressants do not appear to be associated with an increased risk of congenital malformations, but statistical significance was found for cardiovascular malformations. Results were robust in several sensitivity analyses. Given that the RRs are marginal, they may be the result of uncontrolled confounders. Although the RRs were statistically significant, none reached clinically significant levels.

show abstract

“…In the last ten years, however, medical beliefs have dramatically shifted. Pregnancy, once thought to confer a protective effect against bipolar disorder (Grof et al 2000), is now seen as a period of high risk for it (Viguera et al 2002;Viguera et al 2007). Whereas medication was once deemed too risky, the risks that an unmedicated woman poses to herself, her fetus, and those around her now seem to demand pharmaceutical intervention.…”

Section: San Luis Obispomentioning

confidence: 99%