Recurrence of bipolar disorder during pregnancy: a systematic review

Salim, Misbah; Sharma, Verinder; Anderson, Kelly K.

doi:10.1007/s00737-018-0831-4

Cited by 28 publications

(15 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Around 10‐20% of pregnant women with prior depression seem to experience a depressive relapse, but with a broad range of estimates (from <5% to 75%) 24,25 . For bipolar disorder, a systematic review of 14 mainly small studies (including a total of 2,345 women, but with only two studies with a sample size of >100) suggests that around one in five women experience a relapse during pregnancy 24 , with a possible predominance of depressive and mixed episodes (in contrast to prominent manic episodes in the postnatal period) 5,24,25 . However, a recent electronic health record study reported a relapse rate of 10% 26 , possibly reflecting different populations.…”

Section: Prevalence Of Mental Disorders In the Perinatal Periodmentioning

confidence: 99%

Perinatal mental health: a review of progress and challenges

2020

View full text Add to dashboard Cite

Perinatal mental health has become a significant focus of interest in recent years, with investment in new specialist mental health services in some high‐income countries, and inpatient psychiatric mother and baby units in diverse settings. In this paper, we summarize and critically examine the epidemiology and impact of perinatal mental disorders, including emerging evidence of an increase of their prevalence in young pregnant women. Perinatal mental disorders are among the commonest morbidities of pregnancy, and make an important contribution to maternal mortality, as well as to adverse neonatal, infant and child outcomes. We then review the current evidence base on interventions, including individual level and public health ones, as well as service delivery models. Randomized controlled trials provide evidence on the effectiveness of psychological and psychosocial interventions at the individual level, though it is not yet clear which women with perinatal mental disorders also need additional support for parenting. The evidence base on psychotropic use in pregnancy is almost exclusively observational. There is little research on the full range of perinatal mental disorders, on how to improve access to treatment for women with psychosocial difficulties, and on the effectiveness of different service delivery models. We conclude with research and clinical implications, which, we argue, highlight the need for an extension of generic psychiatric services to include preconception care, and further investment into public health interventions, in addition to perinatal mental health services, potentially for women and men, to reduce maternal and child morbidity and mortality.

show abstract

Section: Prevalence Of Mental Disorders In the Perinatal Periodmentioning

confidence: 99%

Perinatal mental health: a review of progress and challenges

2020

View full text Add to dashboard Cite

show abstract

“…Previous studies suggested that women with bipolar disorder may have a lower risk of relapse during pregnancy, when compared to the period before or after (Grof et al 2000). A recent systematic review concluded that based on the literature to date the question of how pregnancy affects the course of bipolar disorder can’t be answered (Salim et al 2018). Viguera et al showed that in women who discontinued mood stabilizing treatment including lithium during pregnancy (n = 62), the relapse risk was two times increased compared to women who continued treatment (n = 27) (Viguera et al 2007).…”

Section: Lithium During Pregnancymentioning

confidence: 99%

Lithium during pregnancy and after delivery: a review

Poels

Bijma

Galbally

et al. 2018

Int J Bipolar Disord

View full text Add to dashboard Cite

Lithium is an effective treatment in pregnancy and postpartum for the prevention of relapse in bipolar disorder. However, lithium has also been associated with risks during pregnancy for both the mother and the unborn child. Recent large studies have confirmed the association between first trimester lithium exposure and an increased risk of congenital malformations. Importantly, the risk estimates from these studies are lower than previously reported. Tapering of lithium during the first trimester could be considered but should be weighed against the risks of relapse. There seems to be no association between lithium use and pregnancy or delivery related outcomes, but more research is needed to be more conclusive. When lithium is prescribed during pregnancy, lithium blood levels should be monitored more frequently than outside of pregnancy and preferably weekly in the third trimester. We recommend a high-resolution ultrasound with fetal anomaly scanning at 20 weeks. Ideally, delivery should take place in a specialised hospital where psychiatric and obstetric care for the mother is provided and neonatal evaluation and monitoring of the child can take place immediately after birth. When lithium is discontinued during pregnancy, lithium could be restarted immediately after delivery as strategy for relapse prevention postpartum. Given the very high risk of relapse in the postpartum period, a high target therapeutic lithium level is recommended. Most clinical guidelines discourage breastfeeding in women treated with lithium. It is highly important that clinicians inform and advise women about the risks and benefits of remaining on lithium in pregnancy, if possible preconceptionally. In this narrative review we provide an up-to-date overview of the literature on lithium use during pregnancy and after delivery leading to clinical recommendations.

show abstract

“…Dentre as particularidades de cada classe de 12,13 . Tenta-se preconizar a administração de medicamentos, durante a gravidez ou aleitamento materno, somente quando são necessários e em menor período possível.…”

Section: Discussionunclassified

Transtorno afetivo bipolar em paciente gestante com trágico desfecho fetal: relato de caso

Previdelli¹,

Spaziani²,

Barbosa³

et al. 2020

Arch Health Invest

View full text Add to dashboard Cite

O Transtorno Afetivo Bipolar (TAB) envolve a psicose, depressão e mania caracterizado por períodos de bom humor e irritação ou depressão, podendo trazer prejuízos para as relações afetivas. No caso de TAB em gestação o tratamento torna-se complicado, pois a escassez de estudos faz com que a terapêutica farmacológica seja suspensa. Sexo feminino, 37 anos. Em tratamento para transtorno afetivo bipolar há 7 anos. Paciente engravidou em 2018 em uso de: Risperidona; Citalopram; Biperideno; Carbonato de lítio; Clorpromazina; Propanolol; Brometazina; Clonazepam. Devido a gestação, descoberta com 20 semanas gestacionais, alterou-se a medicação. Fazia uso de: Clonazepam, Prometazina, Carbonato de Lítio, Haloperidol e Clorpromazina. Com 26 semanas gestacionais, ultrassom gestacional apresentava polidrâmnio. Com 30 semanas gestacionais apresentou dor abdominal de grande intensidade e foi internada. Na manhã seguinte apresentava melhora do quadro álgico, porém tinha 9 polpas digitais de dilatação, colo fino e anterior. Encaminhada para o centro cirúrgico para realização de cesárea com recém-nascido bradicardico e hipotônico que evoluiu com óbito seis dias após. A prescrição e uso de medicamentos na gestação, merece especial cuidado. Os trabalhos na área com gestantes são bastantes escassos, uma vez que estudos nesta fase da vida vão de encontro a princípios da bioética.

show abstract

Recurrence of bipolar disorder during pregnancy: a systematic review

Cited by 28 publications

References 16 publications

Perinatal mental health: a review of progress and challenges

Perinatal mental health: a review of progress and challenges

Lithium during pregnancy and after delivery: a review

Transtorno afetivo bipolar em paciente gestante com trágico desfecho fetal: relato de caso

Contact Info

Product

Resources

About