Bipolar disorder and pregnancy
Proper medication treatment for individuals with bipolar disorder has been a controversial issue for decades. This is especially true for women who have bipolar disorder and become pregnant. Due to the extreme risks that are involved for both the women and the fetus during pregnancy, it is common for women to abruptly stop taking their medication during pregnancy. This can result in even more harm for the women and the fetus.
Screening[edit]
Throughout pregnancy, women are routinely screened for things such as gestational diabetes and hypertension whereas they are not routinely screened for depression or bipolar disorder. Due to the increased risk of women developing bipolar disorder during their childbearing years, researchers have begun to express the importance of screening for depression and bipolar disorder in women who are pregnant. [1] Merrill et al. (2015) found that depressive symptoms that are detected in pregnant women are often connected with bipolar disorder. The prevalence of positive screens for bipolar disorder was similar to the prevalence of positive screens to gestational diabetes and hypertension showing the importance of women being aware of their screening options. [2]
Commonly Used Medications[edit]
Lithium is a common medication used to treat bipolar disorder. This is a U.S. Food and Drug Administration (FDA) approved medication. There have been multiple cases of fetuses who experience cardiovascular malformations, specifically Ebstein’s anomaly, at a higher rate than the general population.[1] Lithium is typically taking multiple times a day to maintain serum levels and avoid peaks. [2] There is no clear evidence whether this benefits the fetus. [3] There has been cases in which lithium levels in the umbilical cord blood is equivalent to maternal blood levels as well as the fetus having a higher level in amniotic fluid than in blood. [4] Although the significance of these cases are unknown, some physicians recommend decreasing the dose of lithium to avoid the high serum levels for the fetus. [5]
Anticonvulsants have also been used as an acute form of treatment for bipolar disorder. Some agents in anticonvulsants can pose as a higher teratogenic risk compared to lithium.[6] There are multiple cases where fetuses who was exposed to anticonvulsants had a much higher rate of having a malformation, including neural tube defects, craniofacial anomalies, growth retardation, and heart defects. [7] One anticonvulsant that has recently been approved as a treatment for bipolar order is Lamotrigine. It is considered a much safer antivonvulsants compared to ones before it that pose a higher teratogenic risk. Due to Lamotrigine being fairly new, there are very few cases to study the effects of this medication on fetuses. The impact of Lamotrigine on the growth of the fetus while in the uterus have not been detailed. [8] The rates of birth defects of those studied was comparative to rates in the general population. [9]
Risks[edit]
Being pregnant and having bipolar disorder can pose many risks for women. When stopping medication treatment, women put themselves at risk for a relapse or mood episode. Approximately 68% of pregnant women who discontinued their medication experienced depressive episodes. [10] Untreated mood episodes such as a depressive or manic episodes can result in preterm labor, elevated levels of stress, and possible decreased birth weight. [11] [12] Research found that women are more likely to stop taking their medication in the first trimester although they were taking the medication leading up to pregnancy. This causes issues because not only can a women possibly experience a mood episode, she may also engage in high-risks behaviors such as smoking or substance misuse. [13] Although stopping medication is dangerous for the women and the fetus, continuing medication can be just as harmful as the risks for the fetus are unknown.
Alternative Treatments[edit]
Although stopping or continuing medication may not be an option for certain women who become pregnant, there are other alternative treatments to consider. [14] Burt et al. (2010) explains the importance of finding a balanced treatment that is unique to each women's needs as well as the fetus's needs. Things such as a women's medication history and support system should be taken into consideration when creating a women's treatment plan during her pregnancy. [15] Education and establishing interventions for women during their pregnancy can provide much needed support when facing challenges during pregnancy and trying to find the correct treatment.
References[edit]
- ↑ Yonkers, K., et al., 2004
- ↑ Yonkers, K., et al., 2004
- ↑ Yonkers, K., et al., 2004
- ↑ Yonkers, K., et al., 2004
- ↑ Yonkers, K., et al., 2004
- ↑ Yonkers, K., et al., 2004
- ↑ Yonkers, K., et al., 2004
- ↑ Yonkers, K., et al., 2004
- ↑ Yonkers, K., et al., 2004
- ↑ (Viguera, A.C., Nonacs, R., Cohen, L.S., Tondo, L., Murray, A., & Baldessarini, R.J. 2000).
- ↑ (Merrill, L., et al. 2015).
- ↑ Taylor, C.L., Stewart, R., Ogden, J., Broadbent, M., Pasupathy, D., & Howard, L.M. (2015)
- ↑ (Taylor, C.L., et al. 2015).
- ↑ Burt, V.K., Bernstein, C., Rosenstein, W.S., & Altshuler, L.L. (2010)
- ↑ (Burt, V.K., Bernstein, C., Rosenstein, W.S., & Altshuler, L.L., 2010).
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