Bipolar symptoms can get worse during (and after) pregnancy

Some women go off their medications when they're pregnant, leaving their condition untreated. "It's a highly vulnerable time for these women," Cynthia Battle says. "They have increased functional demands at this time." (Credit: Sarah Zucca/Flickr)

Women with bipolar disorder are significantly more likely to face psychiatric and childrearing challenges before and after pregnancy compared to women who seek treatment for other psychiatric disorders.

The findings indicate the importance of properly identifying the disorder and developing specific treatments for pregnant and postpartum women, new research shows.


“Similar to what you find with bipolar disorder in the nonperinatal population, the overall level of clinical severity and functional impairment really stands out as being of concern,” says Cynthia Battle, associate professor (research) of psychiatry and human behavior at Brown University.

“It’s a highly vulnerable time for these women,” she says. “They have increased functional demands at this time.”

Pregnancy often disrupts sleep and parenting a newborn can involve getting up several times a night for months, for example. Such sleep problems can potentially trigger new mood episodes among women with bipolar disorder. Also, some women go off their medicines while pregnant out of concern for the health of the fetus, leaving their condition untreated.

To determine the clinical consequences of experiencing an acute disorder at a tricky time, researchers examined the records of 334 women diagnosed with a psychiatric disorder and seeking treatment at Women & Infants Hospital day program, a perinatal-focused partial hospitalization program.

Greater risk of self-harm

Among the women, 32 were diagnosed with type I, type II, or unspecified bipolar disorder. All other patients were diagnosed with different psychiatric disorders, such as major depression, generalized anxiety, post traumatic stress disorder, or obsessive compulsive disorder.

The researchers then conducted a statistical analysis of the records to compare how often the patients with bipolar disorder experienced important psychiatric and maternal problems, compared to women with the other disorders.

“Among those women who were diagnosed with biopolar disorder, there was a significantly heightened risk for self-harm and impairment,” the authors write in the study published online in the Journal of Affected Disorders.

Specifically, more than half of bipolar women had a history of substance abuse, compared to 26 percent of other patients, and 59 percent had a history of suicide attempts compared to 27 percent of other patients.

The researchers also found that more than half of women with bipolar disorder had complications delivering their babies, compared to 27 percent of other patients. While a similar percentage of women with biopolar disorder breastfed their infants, a larger proportion of the women with bipolar disorder (78 percent) reported having trouble with breastfeeding, compared to 42.3 percent of other patients.

Ask the right questions

Because of the serious clinical consequences associated with bipolar disorder, providers need to watch carefully for mania symptoms of elation or irritability that distinguish bipolar disorder from depression, Battle says.

“Often how people present for treatment when they have bipolar disorder is with the depressed mood, so it is important to assess for history of prior mania and also to ask about family history of mania,” she says. “Asking those kinds of questions to help clarify whether this is unipolar depression vs. bipolar is going to be important to guide treatment.”

Among women in the study not diagnosed with bipolar disorder, 75 percent self-reported symptoms of irritability and 24.5 percent reported symptoms of elation.

Upon diagnosis, Battle says, the next question is: “How can we best support women in making reasonable treatment decisions when faced with bipolar disorder during pregnancy?”

One option could be guiding patients to switch to medications that are safer during pregnancy or breastfeeding, so that they don’t go off medications altogether. Connecting them to effective psychosocial therapies is also important.

The National Institute of Mental Health partially funded the study.

Source: Brown University