RESEARCH WEEKLY: Pregnant Women with Bipolar Disorder Face Unique Challenges
By Nina Robertson
Women with bipolar disorder-I (BD-I) and schizoaffective disorder-bipolar disorder (SA-BD) are at a high risk of postpartum psychosis, according to a recent study published in the Journal of Affective Disorders. Approximately 60% of women with bipolar disorder, independent of subtype, experience a perinatal bipolar illness episode and many women experience symptoms both during and after pregnancy. Bipolar disorder-I involves periods of severe mood episodes resulting in mania or depression, while bipolar-disorder-II consists of milder forms of mood elevation resulting in hypomania that alternates with severe depression.
Previous research has found that a large number of women with bipolar disorder have the illness recur within the first six months after child delivery. New research conducted in the United Kingdom compares perinatal recurrence of bipolar disorder in bipolar disorder-I and schizoaffective disorder-bipolar disorder versus bipolar disorder-II/other specified bipolar disorder (BD-ll/BD-OS) and related disorders to determine whether a link exists between a high recurrence of mood episodes in pregnancy and postpartum.
Study details and results
The study, performed by researchers from the University of Worcester and Cardiff University, involved 128 women with a lifetime history of bipolar disorder. Participants were eligible to participate if they were 18 years or older and currently pregnant at greater than 12 week’s gestation. This systematic review followed participants from 12 weeks of pregnancy (baseline) until three months postpartum. A baseline semi-structured interview utilized SCAN (Schedules for Clinical Assessment in Neuropsychiatry), a commonly used psychiatric assessment tool that involves interviews to diagnose severe mental illness. Interviews were conducted by a trained research psychologist or psychiatrist to access the potential presence and onset of mental or behavior disorders within the perinatal period. More assessments were also completed; there were follow-up assessments at the third trimester, clinician questionnaires at two months postpartum and three-month postpartum follow-up interviews.
Of the 128 participants, 97% indicated postpartum psychiatric outcome data. Measuring the postpartum period with DSM-5 criteria, results showed that 90% of episodes of mania and psychosis and 56% of episodes of hypomania occurred within four weeks of childbirth. One in four women with BD-I or SA-BD were more likely to experience mania or psychosis in the postpartum period compared to the 4% of women with BD-II/BD-OS.
Examining further, 90.9% of women with BD-I or SA-BD who experienced an episode with onset during pregnancy experienced at least one postpartum recurrence. Results concluded that mania or psychosis in pregnancy is associated with a seven times increased risk of postpartum mania/psychosis compared to women who do not experience bipolar disorder. Women with BD-I or SA-BD who experience mania/psychosis in pregnancy are at a significantly elevated risk for an illness episode during the postpartum period compared to remaining well.
Implications
Overall, as many as one in five women with bipolar disorder experience postpartum psychosis. Those with bipolar disorder-I and schizoaffective disorder-bipolar disorder are particularly vulnerable. It is essential to isolate the risk factors that place pregnant women with bipolar disorder in vulnerable positions and aim towards goals that focus on prevention and management of episodes. Women with this diagnosis require additional targeted and specialist clinical intervention to reduce the potential risk of postpartum psychosis. Women who have bipolar disorder and are pregnant face a difficult decision regarding the management of their illness, particularly relating to the use of psychotropic medication during the perinatal period. Many women fear that medication might cause harm to the baby and the lack of accessible information leads many to worry about their health and potential episodes that could occur due to abrupt discontinuation of psychotropic drugs. Further research is necessary in order to provide reliable information on shared pregnancy experiences of women with bipolar disorder.
It is essential for patients and clinicians to understand the potential risks of severe postpartum recurrence of bipolar disorder. Highlighting the occurrence of mania/psychosis in pregnancy can give information about the factors for onset of postpartum psychosis that may follow. All women with bipolar disorder should be monitored during pregnancy and after birth. Further studies with larger sample sizes can examine pregnancy factors that may influence risk of perinatal recurrence in women with bipolar disorder, specifically psychotropic medication use.
References
