Where some women will opt to discontinue medications before conceiving and during the first trimester, or longer, frequent visits to your prescribing practitioner will make sense. Abrupt discontinuation of mood-stabilizing medication should also be avoided; it’s better to taper off.
Once off of mood-stabilizing medication, the risk of relapse increases. Some women may not be able to take the risk of stopping medication, or will begin to experience symptoms as they taper down. Here, careful planning and selection of medications less associated with birth defects makes sense. Strategies to minimize risk will include using as few agents as possible, and using medications, often ones that have been around longer, such as the typical antipsychotics, where the relative risks to the fetus are minimal and known.
As roughly half of all pregnancies are unplanned, many women with bipolar disorder will conceive while on medication. The same general planning and discussions of relative risk needs to occur. The difference here is that the fetus has already been exposed to various medications during the first trimester. Goals around treatment will be to maintain the mother’s health and minimize potential risks to the unborn child. The use of ultrasound and possibly amniocentesis (examination of cells from the fluid surrounding the fetus), may help detect serious birth defects early in the pregnancy.
As a woman approaches her delivery date, and immediately after delivery, if she has been off medication this may be the time to restart a mood stabilizer and/or antipsychotic, to decrease the risk of a serious post-partum mood episode. The best studied medication for this is lithium, which has been shown to decrease the relapse rate from 50 percent to lower than 10 percent.