Bipolar disorder in women: Indications for preconception and prenatal maintenance pharmacotherapy
- Victoria Hendrick, MD
Victoria Hendrick, MD
- Clinical Professor
- Department of Psychiatry and Biobehavioral Sciences David Geffen School of Medicine, UCLA
For bipolar patients who plan to or do become pregnant, maintenance pharmacotherapy is often indicated to delay or prevent mood episodes [1,2]. Onset of bipolar disorder in women typically occurs during childbearing years , and most patients are thus at risk for recurrences during pregnancy .
This topic reviews indications for preconception and prenatal maintenance pharmacotherapy in female bipolar patients. Preconception and prenatal maintenance treatment, the teratogenic and postnatal risks of medications used for bipolar disorder, and contraception and preconception counseling for female bipolar patients are discussed separately.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Yonkers KA, Wisner KL, Stowe Z, et al. Management of bipolar disorder during pregnancy and the postpartum period. Am J Psychiatry 2004; 161:608.
- Viguera AC, Whitfield T, Baldessarini RJ, et al. Risk of recurrence in women with bipolar disorder during pregnancy: prospective study of mood stabilizer discontinuation. Am J Psychiatry 2007; 164:1817.
- Merikangas KR, Akiskal HS, Angst J, et al. Lifetime and 12-month prevalence of bipolar spectrum disorder in the National Comorbidity Survey replication. Arch Gen Psychiatry 2007; 64:543.
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington, VA 2013.
- Wisner KL, Zarin DA, Holmboe ES, et al. Risk-benefit decision making for treatment of depression during pregnancy. Am J Psychiatry 2000; 157:1933.
- Stewart DE, Vigod SN, Stotland NL. Obstetrics and gynecology. In: The American Psychiatric Publishing Textbook of Psychosomatic Medicine: Psychiatric Care of the Medically Ill, Second Edition, Levenson JL (Ed), American Psychiatric Publishing, Inc, Washington, DC 2011. p.797.
- Kurki T, Hiilesmaa V, Raitasalo R, et al. Depression and anxiety in early pregnancy and risk for preeclampsia. Obstet Gynecol 2000; 95:487.
- Alder J, Fink N, Bitzer J, et al. Depression and anxiety during pregnancy: a risk factor for obstetric, fetal and neonatal outcome? A critical review of the literature. J Matern Fetal Neonatal Med 2007; 20:189.
- Field T, Diego M, Hernandez-Reif M. Prenatal depression effects on the fetus and newborn: a review. Infant Behav Dev 2006; 29:445.
- ACOG Committee on Practice Bulletins--Obstetrics. ACOG Practice Bulletin: Clinical management guidelines for obstetrician-gynecologists number 92, April 2008 (replaces practice bulletin number 87, November 2007). Use of psychiatric medications during pregnancy and lactation. Obstet Gynecol 2008; 111:1001.
- National Institute for Health and Clinical Excellence. Bipolar disorder: The management of bipolar disorder in adults, children and adolescents, in primary and secondary care. National Clinical Practice Guideline Number 38, 2006. http://www.nice.org.uk/ (Accessed on March 07, 2012).
- Newport DJ, Fernandez SV, Juric S, Stowe ZN. Psychopharmacology during pregnancy and lactation. In: The American Psychiatric Publishing Textbook of Psychopharmacology, Fourth Edition, Schatzberg AF, Nemeroff CB (Eds), American Psychiatric Publishing, Inc., Washington, D.C. 2009. p.1373.
- Lee HC, Lin HC. Maternal bipolar disorder increased low birthweight and preterm births: a nationwide population-based study. J Affect Disord 2010; 121:100.
- Newport DJ, Stowe ZN, Viguera AC, et al. Lamotrigine in bipolar disorder: efficacy during pregnancy. Bipolar Disord 2008; 10:432.
- Viguera AC, Cohen LS, Baldessarini RJ, Nonacs R. Managing bipolar disorder during pregnancy: weighing the risks and benefits. Can J Psychiatry 2002; 47:426.
- Cohen LS. Treatment of bipolar disorder during pregnancy. J Clin Psychiatry 2007; 68 Suppl 9:4.
- Burt VK, Rasgon N. Special considerations in treating bipolar disorder in women. Bipolar Disord 2004; 6:2.
- Keller MB, Lavori PW, Kane JM, et al. Subsyndromal symptoms in bipolar disorder. A comparison of standard and low serum levels of lithium. Arch Gen Psychiatry 1992; 49:371.
- Burt VK, Stein K. Treatment of women. In: The American Psychiatric Publishing Textbook of Psychiatry, Fifth Edition, Hales RE, Yodofsky SC, Gabbard GO (Eds), American Psychiatric Publishing, Inc., Washington, DC 2008. p.1489.
- Cohen LS, Wang B, Nonacs R, et al. Treatment of mood disorders during pregnancy and postpartum. Psychiatr Clin North Am 2010; 33:273.
- Burt VK, Bernstein C, Rosenstein WS, Altshuler LL. Bipolar disorder and pregnancy: maintaining psychiatric stability in the real world of obstetric and psychiatric complications. Am J Psychiatry 2010; 167:892.