Adverse Pregnancy Outcomes and Bipolar Disorder
The increased risks are independent of treatment for the disorder.
Most pregnant women with bipolar disorder who discontinue mood stabilizers have relapses. Yet, mood stabilizers are associated with an increased risk of malformations. To examine pregnancy and birth outcomes in treated versus untreated bipolar disorder, researchers relied on Swedish health registries.
Analyses adjusted for confounders including demographics, smoking, and substance use disorders. Of 332,137 women who gave birth between 2006 and 2009, 874 had a record of at least two bipolar disorder diagnoses. Compared to women without bipolar disorder, women with the disorder were more likely to smoke, to be overweight, and to have substance use disorders. Bipolar women also had higher rates of induced labor, cesarean or instrumental delivery, and preterm delivery.
Of the bipolar women, 320 were treated — i.e., filled a prescription for a mood stabilizer or antipsychotic during pregnancy. The 554 untreated women were significantly more likely to have an infant with microcephaly or hypoglycemia than women without bipolar disorder. Adverse pregnancy or birth outcomes did not differ significantly between treated and untreated women with bipolar disorder. There were too few women taking specific medications to identify differences in risk for malformations.
Comment: The lack of significant differences in adverse pregnancy and birth outcomes in treated versus untreated women with bipolar disorder is a reassuring piece of data for clinicians weighing the risks and benefits of medication during pregnancy. However, this study could not adequately address risk for malformations, which have been documented in many other studies. Importantly, women with bipolar disorder had worse pregnancy outcomes than women without bipolar disorder. Many factors were statistically controlled for; however, others, such as psychosocial stress and instability and substance use not meeting diagnostic criteria, might contribute to these group differences.
Published in Journal Watch Psychiatry November 19, 2012
Boden R et al. Risks of adverse pregnancy and birth outcomes in women treated or not treated with mood stabilisers for bipolar disorder: Population based cohort study. BMJ 2012 Nov 8; 345:e7085. (http://dx.doi.org/10.1136/bmj.e7085)
- brief guidelines for BipolarDisorder pregnant patient
Walter Doege, private office, 26 Nov 2012 11:50 AM EST
Bipolar Disorder (BD) is a serious and common psychiatric disorder. Pregnant BD patient shall always receive psychiatric treatment (psychotherapy, pharmachotherapy,... [more]
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