Relapse of Bipolar Disorder During Pregnancy Increases Risk of Postpartum Illness

Catherine K


In arranging for being pregnant, ladies with bipolar condition and their care vendors are forced to make difficult options.  In the placing of treatment discontinuation, relapse charges are important, and there is proof that untreated psychiatric disease in the mom is affiliated with worse maternal and fetal results.  Nevertheless, a lot of of the drugs frequently utilised to treat bipolar problem, specially lithium, have a small but measurable boost in hazard of teratogenesis.  The reproductive security of other medicines, like atypical antipsychotic remedies, is not effectively characterised. These choices are even more sophisticated by the paucity of data pertaining to the training course of bipolar illness throughout pregnancy.

A new study from the United Kingdom appears especially at recurrence of sickness through being pregnant and the postpartum time period in a team of ladies with bipolar dysfunction.  This research incorporated 128 women of all ages with DSM-5 bipolar problem (BD) who had been recruited to the Bipolar Problem Research Community Being pregnant Study and have been followed from 12 weeks of gestation to 12 weeks postpartum. Semi-structured questionnaires, supplemented with clinician interviews and evaluate of the clinical record, were utilized to evaluate for lifetime psychiatric record and psychiatric ailment through being pregnant and the postpartum abide by-up.  

In this cohort, 98 women of all ages experienced bipolar I ailment/schizoaffective-BD (BD-I group) and 26 bipolar II problem/other specified BD and similar ailment (BD-II group).   The two teams were equivalent, though the women of all ages in the BD-II team had before onset of ailment and had a lot more regular depressive episodes than females with BD-I.  Info relating to the use of drugs for the duration of being pregnant was not described.  About 40% of the ladies in every single team used a temper stabilizer during the postpartum period of time.   

  • Perinatal recurrence of disease was typical in both teams: 57% (BD-I) and 62% (BD-II) knowledgeable a temper episode throughout pregnancy. 
  • Girls with BD-I were being additional most likely to encounter mania/psychosis throughout being pregnant than girls with BD-II (13.5% vs. %).
  • Girls with BD-I were a lot more probable to working experience mania/psychosis inside of 6 weeks postpartum (23%) as opposed to gals with BD-II (4%). 
  • In women with BD-I, mania/psychosis during being pregnant was connected with a sevenfold increased possibility of postpartum mania/psychosis (RR 7., p<0.001). 

 In women with BD-I, depression during pregnancy was associated with a threefold increase in risk of postpartum depression  (RR 3.18, p=0.023).

This study is consistent with previous reports suggesting that risk for perinatal recurrence of bipolar disorder is high, with approximately 60% of women with bipolar disorder (type I or II) experiencing recurrent illness during pregnancy and/or the postpartum period.  Also consistent with previous reports is the finding that depressive episodes are more common than mania in women with BD-I and BD-II however, mania/psychosis is much more common in women with BD-I than those with BD-II. (In this study, only one of the 26 women with BD-II experienced postpartum mania/psychosis.)

The Importance of Remaining Well During Pregnancy

Of great clinical significance is the observation that women who experience recurrent illness during pregnancy are more likely to experience illness during the postpartum period.  The highest risk was observed in women with BD-I in this study, women who experienced mania/psychosis during pregnancy had a sevenfold increased risk of experiencing postpartum mania/psychosis.  Overall, recurrence of illness during pregnancy (depression or mania) was associated with a twofold increase in risk for postpartum illness.  

It is clear that risk for postpartum psychiatric illness, including postpartum psychosis, is high in women with bipolar disorder.  Previous studies have demonstrated that risk for postpartum illness can be reduced significantly with the use of a mood stabilizer, such as lithium, during the postpartum period.  However, given the risks associated with the use of certain mood stabilizers during pregnancy, many women and their providers elect to discontinue mood stabilizers during pregnancy.  This study confirms previous studies documenting high rates of recurrent illness during pregnancy in women with bipolar disorder, but the findings of this study also suggest that the discontinuation of mood stabilizers during pregnancy may have significant implications for vulnerability to postpartum psychiatric illness.

In women with unipolar depression, relapse during pregnancy is a robust predictor of postpartum depression this study indicates that for women with bipolar disorder, recurrent illness during pregnancy, especially mania or psychosis, is a robust predictor of postpartum psychiatric illness. While certain mood stabilizers, including lithium carry some risk of teratogenesis, we need to weigh the relatively small risk of teratogenesis in mood stabilizers, excluding valproic acid, against the very high risk of recurrent illness during pregnancy in the mother. Avoiding medication during pregnancy and restarting it after delivery may not be the best option.  This study, and others, suggests that keeping the mother well during pregnancy will reduce the risk of postpartum psychiatric illness.

Ruta Nonacs, MD PhD

 

Perry A, Gordon-Smith K, Di Florio A, Craddock N, Jones L, Jones I. Mood episodes in pregnancy and risk of postpartum recurrence in bipolar disorder: The Bipolar Disorder Research Network Pregnancy Study. J Affect Disord. 2021294:714-722. 

 

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