Bipolar disorder, a disease characterized by mood swings and cyclic manic behavior, affects between 0.5 percent and 1.5 percent of people in the United States, according to Dr. Kimberly Yonkers of Yale University of Connecticut and lead author of a study published in the April 2004 issue of the American Journal of Psychiatry. Bipolar disease often manifests itself during the teenage years or early 20s, a time when many young women become pregnant. Having bipolar disease during pregnancy and in the postpartum period poses significant risks for mother and fetus.
Medication Risks
Many of the medications used to treat bipolar disorder have side effects that can potentially harm a developing fetus. Lithium, a first-generation mood stabilizer, increases the risk of a specific heart defect called Ebstein's anomaly in the fetus, although the risk is still small, around .05 percent to 0.1 percent, Yonkers reports. Anticonvulsants may double the risk of neural tube defects, craniofacial malformations or heart defects. Valproate in particular causes neural tube defects in 5 percent to 9 percent of fetuses. Babies may have floppy baby syndrome at delivery, with poor muscle tone and cyanosis, a bluish discoloration from low oxygen levels.
Second-generation antipsychotic medications aren't well studied in pregnancy, but olanzapine, sold as Zyprexa, increases the risk of maternal gestational diabetes, the National Alliance of Mental Illness, NAMI reports. Gestational diabetes can cause macrosomia and hypoglycemia in the newborn.
Maternal Risks
Pregnancy and the delivery increases the risk of exacerbation of bipolar disease, with pregnant women experiencing a sevenfold increase in hospital admissions and a twofold increase in recurrent episodes compared to non-pregnant women, NAMI reports. Women who stopped taking prescribed medications six months before getting pregnant to 12 weeks into a pregnancy were much more likely to experience at least one recurrence, 85 percent compared to 37 percent who stayed on their medications. They also experienced symptoms throughout the pregnancy at a rate of 40 percent, compared to 8.8 percent of women who continued medications, NAMI adds.
Postpartum Risks
The postpartum period is a particularly likely time for relapse and mood episodes to occur, warns Dr. Marlene Freeman of the University of Texas in a December 2007 article published in the American Journal of Psychiatry. Lithium given postpartum was found to decrease the risk from almost 50 percent to less than 10 percent, Yonkers reports. As many as 57 percent of women diagnosed with postpartum depression actually had bipolar disorder, professor Verinder Sharma of the University of Western Ontario reports in the May 2010 issue of Bipolar Disorders.
References
- National Alliance on Mental illness: Managing Pregnancy and Bipolar Disorder
- American Journal of Psychiatry: Bipolar Disorder and Pregnancy: Risks Revealed; Marlene Freeman, M.D.; December 2007
- American Journal of Psychiatry; Management of Bipolar Disorder During Pregnancy and the Postpartum Period; Kimberly Yonkers, M.D. April 2004
- Bipolar Disorders: Identification of Bipolar Disorder in Women with Postpartum Depression; Verinder Sharma
