One of the most exciting yet complicated times for a person with bipolar disorder is during a pregnancy. Questions about what to do with medications, external stress triggers, and hormones abound. In this guide, we will look at the issues and treatments for a woman with bipolar disorder during pregnancy.
1. The Research
This guide will give you the information that people have collected, as well as feedback from doctors who have treated pregnant women with BP over the last seven years. You can get the most up-to-date information from the NIMH, NAMI, and DBSA websites.
Always check with your doctor (psychiatrist, geneticist, obstetrician, nurse practitioner) before using any of the treatment options that may be suggested in this guide.
2. The Issues of Pregnancy
Women who have bipolar disorder have some special issues surrounding pregnancy:
- Should I go off my medication?
- If I do, what are the chances I will have an episode?
- If I don’t, what are the chances that if I continue my medication, will it affect my unborn child?
Although hormones and bipolar disorder are usually a difficult combination, it seems like Mother Nature helps out with bipolar women who are in a stable environment. Most women report (and so does the spouse) that there seems to be an added stability even after pregnancy.
One doctor treats environmentally stable pregnant women with BP by prescribing haloperidol PRN as needed. Most stable women end up not needing to take it, but if they can’t sleep to the point that they may have an episode, a woman can safely take haloperidol which has been classified as “insignificant” for causing birth defects.
Women who suddenly stop their medication (pregnant or not) are more likely to have bipolar symptoms. Women who discontinue meds from six months before pregnancy to 12 weeks into pregnancy are twice as likely to have an episode. Women who discontinue meds experienced symptoms during almost half of their pregnancy, while those who continued meds experienced symptoms less than 10 percent of the time.
Obviously, planned pregnancy is the way to go, if you can. Gather up all the information you can, talk to your doctor (obstetrician, psychiatrist), and do this before conception. This will give you the best advantage to prevent episodes, birth defects, and family discord. Get all this settled before the child is even a glint in Mama’s eye.
The medications rated the best for being “insignificant” for causing birth defects are first generation medications (haloperidol and thorazine). They have been around long enough to be measured. Lithium has also been around for a long time. When lithium is used in the first trimester, there may be cardiac problems with the baby after the baby is born. The overall risk for anomalies is 4 to 12 percent (as shown by several studies). Lithium is much safer in the second and third trimester. If Mom decides to nurse the baby while on lithium, the baby should be checked for lithium blood levels.
Valproic acid has also been studied and shows an overall high risk for birth defects when taking 1,000 mg or more daily. It is determined to be safe in the eighth and ninth month, according to feedback. Vitamin K is recommended for mothers who are taking valproic acid. Tegretol is not recommended during pregnancy. Lamotrigne shows a small risk (if any) of birth defects for any major anomalies. The birth defect research of the other newer medications is not confirmed. Preliminary information from early studies indicate that olanzapine does not cause birth defects, but it has been associated with weight gain and diabetes. Weight gain and diabetes are significant concerns for the birth mother. An assessment for birth defects is significant because it may affect your child for a lifetime.
It is recommended that expecting women take only one bipolar medication, as it is less harmful to the fetus than two or more. The dosages should be divided up throughout the day instead of taken all at once. If a woman is on lithium during pregnancy, she should keep herself hydrated (even more trips to the bathroom!) and the infant should be checked for lithium levels right after birth. If lithium is continued after birth, it reduces the possibility of bipolar symptoms to 10 percent.
4. Other Treatments
Electroconvulsive therapy (ECT) has fewer risks for the fetus than any of the medications. The heart rate and oxygen levels of the fetus can be monitored during ECT, which would detect any problems. Pregnant women who utilize ECT should make sure they are hydrated and have the proper diet and vitamins. In these cases, there is little probability of premature contractions.
Psychotherapy has been shown to improve the general day-to-day functioning of pregnant women.
Exercise (not manic overexertion) is helpful during pregnancy. Relaxation techniques and yoga seem to have great benefit. Massage is relaxing. Be sure to go to a therapeutic massage therapist who has been educated in the proper techniques for pregnant women. There are certain points of the body that should be avoided in massage so as not to cause contractions.
Sleep is perhaps the most important part of maintaining stability in all cases. A woman may be pregnant with BP and be missing sleep to the point where she is getting run down, or is unable to sleep at all. It may be time to ask the doctor for some haloperidal, and ask loved ones for assistance in the judgment of taking medication for sleep. Here are some tips that can help you to get a perfect night’s sleep.
7. Feedback From the Front
Feedback from mental health-care workers (psychologists, social workers, counselors, nurse practitioners, and M.D.s) over the last eight years indicate that, although hormones and bipolar disorder is usually an exacerbating combination, many women with BP say that they feel great when pregnant. These are women with stable lives who go off their medication slowly for a planned pregnancy, listen to their doctors, research the information available, and plan their pregnancy in advance. Other women who may have unplanned pregnancies, don’t know who the father is, or decide to give the baby up for adoption are likely to have more difficulties.
8. After the Birth
One of the critical periods is after the baby is born. Avoiding the postpartum blues is of significant importance. What may look like postpartum blues may actually be a severe bipolar depression triggered by circadian rhythm changes (changes in sleep pattern).
One way to avoid this is to have someone other than Mom get up with the baby. Maybe Grandma will move in for the first couple of months, or maybe Dad will agree to get up with the baby at night. Mom should be left to sleep through the night.
Post-traumatic stress disorder (PTSD) may come along with a difficult birth (up to 6 percent of the time). It is the second worst combination with BP (trauma and BP). The worst combination is BP and hormones. If it was a traumatic birth, this is liable to wake up the bipolar monster. If this is so, Mom is going to need a stress-free environment as much as possible and treatment for her PTSD (as anyone would who had trauma).
Armed with this information, pregnancy for a woman with bipolar disorder doesn’t have to be worrisome. With proper management and a great support system, it will be a glorious time! Good luck!