and Bipolar Disorder
women who are bipolar and of childbearing years have the same questions.
Mainly, "Can I be pregnant and still take my medications?" and
"Can I pass this disorder to my unborn child?"
article will attempt to give you up to date information
available, and link you to some personal accounts. All of the personal
accounts may not be positive, but you should hear both sides of the
story from women who have actually gone through a pregnancy after being
diagnosed with bipolar disorder.
talk about the technical things first. Most of current articles
indicate the same thing, there have not been enough controlled studies
in many areas, especially on the effects of medication, on the
developing fetus or the effects of being off of medication on the
recent studies it has been shown that 1% to 3 % of the general
population have bipolar disorder in one form or another. When either
parent is bipolar, however, that risk increases to 15%.
are ongoing studies being done by the National
Institute of Mental Health in Washington, D.C. at John's Hopkins
University, Indiana University, Washington University, and many
regards to being pregnant and taking medications, there are relatively
few studies done on the newer medications that are in use currently,
but, the information available suggests strongly that if at all
possible, medications should be avoided in the first trimester of
pregnancy, that is the first three months. This is the time that the
fetus develops their internal organs like the brain, spinal cord, lungs,
heart, liver, kidneys, intestines and stomach. For this reason, the
following tips have been suggested:
Avoid unplanned pregnancies. Use a reliable contraceptive. Most
congenital defects occur in weeks 4-10 of development, when the organ
development is at a critical point. Medications like Carbamazepine,
(tegretol), can also decrease the effects of contraceptive absorption,
therefore, higher doses of contraceptive may be needed.
Before becoming pregnant, discuss the possibilities thoroughly with your
psychiatrist and your gynecologist. They must both have a good
understanding of your disorder and the effects of medication at
different times of the fetal development, labor and delivery, postpartum
and breast feeding issues.
If possible your medication can be titrated or slowly decreased until
you are off the medication altogether. It is best to wait a one(1) month
period as a safety zone between taking your last medication and trying
Most medications are passed through the breast milk. Because of this,
breast feeding issues must also be discussed with both the psychiatrist
and neonatal (baby) doctor to weigh the benefits of both the mother and
child if the mother is to continue medications or resume them after
Psychosis is the greatest risk of all to both the mother and the fetus.
If the risk of returning episodes of extreme mania or depression
increases, it is in the best interest of both the mother and the fetus
to resume medications. Psychotic illness episodes in unmedicated
pregnant women is four (4) times more common. Poor nutrition,
hypersexual activity (increased risk of contracting a sexually
transmitted disease such as HIV), refusal of prenatal care, impulsive
decisions, feticide, and inability to cope with complications of
pregnancy are the most common episode induced behaviors.
general, the risks of fetal complications have been shown to be lower
than once thought, and if it has been deemed that the mother must
continue medications for her safety and the safety of the fetus, then it
far outweighs the risks of being unmedicated.
are put into categories as to how they affect the developing
fetus. Below is a list of those categories: (Thanks Dr. Phelps for
human studies have demonstrated no fetal risk.
Category B: Animal studies indicate no fetal risk, but no human
studies OR adverse effects in animals , but not in well-controlled human
Category C: No adequate human or animal studies, OR adverse
fetal effects in animal studies, but no available human data.
Category D: Evidence of fetal risk, but benefits outweigh risks.
Category X: Evidence of fetal risk.
Risks outweigh any benefits.
of the medications taken for mental illness are in "Category
C". Again, however, many of the newer medications have not
had complete studies done on human pregnancies. Check out our
medication search engine
, towards the bottom of the page, to check on your specific medication
to Dr. Laura Miller, Assistant Professor of Psychiatry at the University
of Illinois, many of the older studies done on pregnancy and psychiatric
medications are flawed because they did not take into consideration the
following factors: nutritional status of the mother, physical and
emotional stresses during the pregnancy, maternal age and environmental
factors such as exposure to toxic chemicals and smoking by the
side effects of psychiatric medications on pregnancy include, increase
risk of miscarriage, increased risk of premature birth and increase risk
of physical and behavioral malformations due to the effect many of the
medications can have on the developing neurotransmitters (nerve
of the better studied medications is lithium, and although it was once
thought to be a significant risk in congenital heat disease, recent
studies have shown that risk to be milder now at 4% -12%.
medication has also been shown to cause an increased incidence of
hypothyroidism (low thyroid output) in the new born. This is usually
corrected once the lithium leaves the newborn's system.
the fetus diabetes insipidous has also occurred, which
usually clears up when the medication is stopped or after delivery.
must be reduced to 50% during labor to prevent fluid retention as well
as fetal and maternal toxicity. If the mother develops any respiratory
or breathing problems, the medication must be discontinued.
is best to monitor serum levels frequently and to keep the therapeutic
levels of the medication low. It is also better to take more frequent
lower doses of the medication to prevent high peak blood levels and
maintain a constant level.
is imperative that the mother avoid alcohol consumption of any kind
during the pregnancy when taking lithium.
stated before it is best for the mother to avoid lithium in the first
trimester if possible. It is much safer in the second and third
trimesters, in spite of this, if used just prior to delivery, newborns
will tend to be lethargic and listless, have shown to have an irregular
sucking and startle response and are often cyanotic (blue) due to the
poor absorption of oxygen in the blood.
conditions improve in the postpartum period (after birth), as the
lithium leaves the infant.
the mother chooses to breast feed, the newborn must also have lithium
levels done on a frequent basis, as it is secreted in the breast milk.
Dehydration in the infant must be avoided as the lithium blood levels
could reach toxic levels very quickly.
(valproic acid) and Carbamazepine (tegretol) have both been shown to
cause an increase in neural tube defects by 4-6%, mainly spina bifida,
(malformation of the spinal column), and should be avoided in the
first trimester, they are safer in the second and third trimester.
have been shown to affect the metabolism or body's use of vitamins as
well. It is recommended that if these medications must be given during
the second and third trimester that a folate, (Vitamin B group), vitamin
supplement be given.
Carbamazepine is used then the mother should be given vitamin K in the
last month of pregnancy and the newborn given a one time shot of vitamin
K at birth. Both Carbamazepine and Depakote may cause convulsions
in the newborn, as a result of withdrawal, on the other hand, if the mother
breast feeds, this risk is greatly reduced. Both
have been shown to be safer overall for the newborn during breast feeding,
nonetheless, blood levels on the newborn are necessary.
a whole, it is very clear that much still needs to be discovered about
medications in general and bipolar pregnancies. Short term and
long term effects on animal studies and humans taking certain
medications have not been compiled.
addition to this article, we invite you to read the personal stories of
some of our members. Click here to go to personal
stories and site links related to pregnancy and bipolar disorder.
NIMH has recently published a new medication pamphlet on medications for
mental illness. It includes pregnancy warnings and a comprehensive
list of medicines. Check it out at:
you would like to include your pregnancy or post partum story please
contact Bipolar World at
Ed van Gent, Pieternel Kolling, Elise Knoppert-van der Klein :
PREGNANCY, MATERNITY AND THE MANIC DEPRESSIVE DISORDER http://www.antenna.nl/lithium/englishweb/guidelines/pregnancy_s.html
Rita A. Suri, MD, Lori L. Altshuler, MD Viven K burt, MD Phd,
Victoria Hendrick MD : MANAGING PSYCHIATRIC MEDICATIONS IN THE
Dr Valerie Raskin : MEDICATION, PREGNANCY AND LACTATION