Prophylactic Management of Women With Bipolar Disorder During Pregnancy and the Perinatal Period

Abstract

Many women with bipolar disorder experience episodes of illness or relapses over the perinatal period, especially in the immediate postpartum period. Risks associated with treated/untreated psychopathologies and fetal exposure to bipolar medications make the management of bipolar disorder during these periods challenging for clinicians and patients. In light of the available effectiveness and reproductive safety data, the current clinical update based on the opinions of a group of international perinatal psychiatry authors recommends general considerations and specific management strategies for each possible clinical scenario, including mixed features, predominant polarity, diagnosis of subtypes of bipolar disorder, severity of previous episodes, and risk of recurrence of mood episodes.

Question

“…Shared decision-making that includes exploring and comparing the benefits, harms, and risks of each option through discussion of what matters most to the patient is essential in preconception planning. Treatment options for this patient can include lithium and/or second-generation antipsychotics throughout the perinatal period 4 . Lithium prophylaxis can dramatically help maintain mood stability during pregnancy and reduce the risk of postpartum relapse.…”

A case of pregnancy with severe polyhydramnios related to long‐term use of lithium

“…It should also be noted that there is no consensus concerning the risk of discontinuation of medication during pregnancy. Nevertheless, lithium is recommended as preferential treatment for bipolar disorder during pregnancy 1 . It is expected that many women in reproductive age are taking lithium since the prevalence of bipolar disorder spectrum is around to 2%.…”