Factors Influencing Women with Bipolar Disorder and Pregnancy

The desire of many women with bipolar disorder to become pregnant often supersedes their concerns about their disease. Women with bipolar disorder are at high risk for a mood episode in the immediate postpartum period. One in 5 suffers postpartum psychosis, and up to half experience a depressive episode. Patients who are planning to become pregnant must consider whether they will change their medications to prevent fetal harm, and how to plan for the postpartum period.

TheBritish Journal of Psychiatry Openpublished study results in its September 2016 issue that show providers should educate women with bipolar disorder about the relationship between their disorder and pregnancy.

The researchers sampled women of childbearing age with bipolar disorder who were pregnant, considering pregnancy, or pregnant in the past. They supplemented this qualitative assessment with data from an online forum. The study enrolled participants at National Health Service clinics and Bipolar UK workshops.

Patients in the study expressed many fears, such as:

• Relapsing if they change their medications to avoid teratogens
• Harming their fetus if they continue on the same therapy
• The inheritability of bipolar disorder, although disease inheritance is not a guarantee. These fears go beyond the healthcare realm to include concerns about social services taking away their child due to “bad parenting.”

Childbirth, especially if prolonged, is a stressful event that can precipitate a relapse or worsening of bipolar disorder. Some women seek Caesarean sections to avoid a stressful delivery, but providers should discourage unnecessary Caesarean sections.

Stigmatizing attitudes toward mental illness can affect the choices women make about their treatment. Some women may choose not to take their medication postnatally because of the pressure to breast-feed. Provider support of bottle-feeding by women who cannot breast-feed is crucial for the well-being of both the mother and child.

Surrogacy and adoption are other methods of fulfilling a patient’s desire to be a mother, without the psychological and physical stress of pregnancy and childbirth. However, fear of judgmental officials in social services departments prevents many women from attempting to adopt.

These findings inform all providers of pregnant women, not just psychiatric staff, about patients’ concerns regarding their disorder in relation to having children. Providers should provide an understanding environment with less stigmatization in order to offer proper support and counseling to women with bipolar disorder who plan to become pregnant.