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Bipolar Disorder in Pregnancy and Postpartum: Principles of Management

  • Women's Mental Health (CN Epperson, Section Editor)
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Abstract

Pregnancy and postpartum represent times of increased vulnerability for women with bipolar disorder, yet this condition remains under-diagnosed and under-treated. As 50 % of pregnancies are unplanned, the risks associated with the illness and the potential risks associated with treatment should be considered when a woman of reproductive age first presents for evaluation. This article reviews the epidemiology of perinatal bipolar disorder, screening recommendations, and treatment with pharmacotherapy and electroconvulsive therapy (ECT). An overview of the data in pregnancy and lactation is presented for lithium, lamotrigine, valproic acid, newer antipsychotics, and ECT. General principles of management include close monitoring in pregnancy and postpartum, careful adjustment of the treatment regimen to attenuate the risk of relapse, and avoidance of valproic acid when possible. Thoughtful consideration of these issues will minimize the risks to the mother and baby.

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Authors and Affiliations

  1. Department of Psychiatry, New York University School of Medicine, New York, NY, USA

    Sabrina J. Khan

  2. Department of Consultation-Liaison Psychiatry, Long Island Jewish Medical Center, New Hyde Park, NY, USA

    Madeleine E. Fersh

  3. Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Carrie Ernst & Kim Klipstein

  4. Consultation Psychiatry Mount Sinai Health System, New York, NY, USA

    Kim Klipstein

  5. Behavioral Medicine and Consultation Psychiatry, Mount Sinai Medical Center, New York, NY, USA

    Kim Klipstein

  6. Department of Psychiatry, Icahn Medical School at Mount Sinai, New York, NY, USA

    Elizabeth Streicker Albertini

  7. Psychiatry, Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Shari I. Lusskin

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Correspondence to Sabrina J. Khan.

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Sabrina J. Khan, Madeleine E. Fersh, Carrie Ernst, Kim Klipstein, and Elizabeth Streicker Albertini declare that they have no conflict of interest.

Shari I. Lusskin has received expert testimony fees from Pfizer (sertraline litigation; consultant involving venlafaxine litigation). Dr. Lusskin has also received royalties from UpToDate.

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Khan, S.J., Fersh, M.E., Ernst, C. et al. Bipolar Disorder in Pregnancy and Postpartum: Principles of Management. Curr Psychiatry Rep 18, 13 (2016). https://doi.org/10.1007/s11920-015-0658-x

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  • DOI: https://doi.org/10.1007/s11920-015-0658-x

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