Treating Bipolar Pregnancies A review of recent literature

Introduction and Epidemiological data: Using the World Health Organization

Composite International Diagnostic Interview carried out in eleven countries worldwide (along
with Romania), lifetime prevalence of Bipolar Disorder was estimated to range between 0.3 - 1.5%
worldwide, specifically 0.6% - BP I, 0.4% - BP II, 1.4% - subthreshold BP, and 2.4% for bipolar
spectrum. (1)
According to the CDC, the ratio of women to men suffering from Bipolar Disorder is
estimated to be 3:2. (2) The median age of onset is 25 (2), whereas the average age for pregnancy
in European women is 29 (3).
As such, in the case of women living with BP, most of them during their reproductive
years, the prenatal planning and the careful management and treatment during the ante/intra-natal
and postpartum period are important issues to address.

Diagnosing BP in a pregnant woman:

Pregnancy planning:
The subject of a possible pregnancy must be brought into discussion with any patient of
reproductive age (half of all pregnancies are unplanned).(4) Some of the essential aspects to
discuss are: the importance of a reproductive plan and the consequences that an unplanned
pregnancy has on the patient (whether she is undergoing treatment or not), her ability to manage
(sub-threshold)-symptoms during and in the months after the pregnancy and the impact the
treatment or the untreated illness has on the foetus/infant.
The best attitude is to avoid prescribing drugs known for their teratogenic properties
(valproate and carbamazepine are good examples) to women with child bearing potential or, if it
cannot be done, an effort must be made to stress the impact they have on an unplanned pregnancy.
(5) Many sources specifically state that treatment with valproate should be a last resort in women
not of menopausal age. (5)
 A reproductive plan allows the patient to make an informed and safe decision regarding if
and when to remain pregnant, but also to consult with her clinician regarding the risks and benefits
of (dis)continuing or switching medication before and during the course of the pregnancy.

References
1 - Merikangas KR, Jin R, He J-P, et al. Prevalence and correlates of bipolar spectrum
disorder in the World Mental Health Survey Initiative. Arch Gen Psychiatry. 2011;68(3):241-251.
2 - https://www.cdc.gov/mentalhealth/basics/burden.htm
 3 http://ec.europa.eu/eurostat/documents/2995521/6829228/3-13052015-CP-
EN.pdf/7e9007fb-3ca9-445f-96eb-fd75d6792965
4 de La Rochebrochard E et al. Children born after unplanned pregnancies and cognitive
development at 3 years: social differentials in the
United Kingdom Millennium Cohort. Am J Epidemiol 2013; 178:910920.
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