Helping a woman with bipolar disorder manage her symptoms and medications through pregnancy involves highly individualized care. Key issues that need to be addressed explicitly include:
• The particular woman’s history of bipolar disorder, especially the frequency with which she has had previous mood episodes. If she has gone years between episodes, coming off medications in order to get pregnant and through the first trimester, or longer, may be the way to go.
• The woman’s reproductive history, age and general medical history. Is this someone who may not get pregnant for a period of time and/or will require the additional assistance of a fertility specialist? If the decision is to come off medications, the increased time to conceive will also increase the overall risk of having a mood episode.
• Understanding potential risks to the developing fetus of different medications. In general, the risks are greatest in the first trimester when the major organ systems are developing. Certain medications, such as the anticonvulsants valproic acid (Depakote) and carbamazepine (Tegretol), are typically avoided. Likewise, multiple medications increase the overall risk to the fetus. It’s also important to understand that even though medications may increase the risk of certain birth defects, there’s always an underlying risk for these same events even off of medication. In other words, it’s not always the medication that causes a problem.
• Understanding potential risks to the health of both the mother and the unborn child should a major mood episode develop in the course of the pregnancy.
• Understanding the risk for developing a mood episode toward the end of pregnancy and the period after (postpartum), and the potential dangers this represents to both the mother and child.
• Encouraging overall good prenatal care and health. This includes eliminating all alcohol, drugs, and tobacco; regular visits and screenings with the obstetrician/obstetrical clinic; attendance at birthing classes; good nutrition; pre-natal vitamins; etc.
For women with bipolar disorder who want to have children and minimize the risks to both their own health and that of their baby, planning is critical and should start before conception. It is important that you, your spouse, your psychiatrist, your obstetrician, and other major supports are working together as a team.