Special Pregnancy Concerns for Bipolar Women

pregnancyWomen who have bipolar disorder often have a particular set of issues that need to be addressed during the period before and after childbirth.[1] These women have the potential for significant mental health problems that lead to early mothering challenges; therefore, correctly identifying and treating their disorder during and after pregnancy is important.1

Associate Professor of Psychiatry and Human Behavior at the Alpert Medical School of Brown University, Dr. Cynthia Battle, said, “Similar to what you find with bipolar disorder in the non-perinatal population, the overall level of clinical severity and functional impairment really stands out as being of concern. [Pregnancy and motherhood are] highly vulnerable times for these women.”1

Battle goes on to say, “Women have increased functional demands at this time. Pregnancy often disrupts sleep and parenting a newborn can involve getting up several times a night for months. Such sleep problems can potentially trigger new mood episodes among women with bipolar disorder.”1

In order to determine the clinical consequences of experiencing this disorder during a sensitive time, Battle and colleagues examined the records of 334 women who were diagnosed with a psychiatric disorder and seeking treatment at the Women & Infants Day Hospital Program—a perinatal-focused partial hospitalization program.1

Among the 334 women, 32 were diagnosed with bipolar disorder.1 All of the other patients were diagnosed with other psychiatric disorders, such as depression, anxiety, PTSD, and OCD.1 Battle and colleagues conducted a statistical analysis of all the women’s records to compare how often the patients with bipolar disorder experienced psychiatric and maternal problems, compared with all the other patients.1

Battle said, “Among those women who were diagnosed with bipolar disorder, there was a significantly heightened risk for self-harm and impairment.”1

Further, more than half of the patients with bipolar disorder had a history of substance abuse, compared to 26 percent of the other patients.1 Also, 59 percent of the patients with bipolar disorder had a history of suicide attempts, compared with 27 percent of other patients.1 Women with bipolar disorder were more likely to have complications when delivering their babies, and had a more difficult time breastfeeding.1

At times, bipolar disorder goes undiagnosed until post-partum.1

“Because of the serious clinical consequences associated with bipolar disorder, providers need to watch carefully for mania symptoms of elation or irritability that distinguish bipolar disorder from depression,” said Battle. “Often how people present for treatment when they have bipolar disorder is with depressed mood, so it is important to assess for history of prior mania and also to ask about family history of mania.”1

In the study, among the women who were not diagnosed with bipolar disorder, 75 percent reported symptoms of irritability and 24.5 percent reported symptoms of elation after giving birth.1

When women who are already diagnosed with bipolar disorder become pregnant, it is important to guide their treatment with the health of both the mother and fetus in mind.1 One option is to have patients switch to medicines that are safer during pregnancy and breastfeeding, so they do not have to come off medicines altogether.1 This will allow them to maintain control of their disorder and experience less negative symptoms.1 Also, psychosocial therapies should be used to help women with bipolar disorder through this special, yet often difficult time.1

[1] Nauert, R. (2014). Bipolar Women Have Special Pregnancy Concerns. Psych Central. Retrieved on February 26, 2014, from http://psychcentral.com/news/2014/02/25/bipolar-women-have-special-pregnancy-concerns/66385.html

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