Bipolar Disorder and Pregnancy: What to Expect and How to Manage the Risks

Managing bipolar disorder during pregnancy can be difficult. Because it’s a lifelong mental health condition, bipolar disorder requires long-term, ongoing treatment. If you’re thinking about conceiving or currently pregnant with bipolar disorder, you’ll want to notify your team of providers immediately. 

We dive into the potential complications that can occur in pregnant women with bipolar disorder and how best to manage bipolar disorder during pregnancy. While there’s no one-size-fits-all approach to managing this mental illness, there are things you can do to protect yourself and the unborn child.

Complications Associated With Bipolar Disorder in Pregnancy

Bipolar disorder treatment varies from person to person. If you’re managing the condition without medication, you may not need to adjust your treatment during pregnancy. However, you may still want to consult with a perinatal psychiatrist, ideally in advance of conception. They can review your history and discuss if prophylactic medication to avoid relapse is appropriate, and/or if starting medication after delivery is a possible option to minimize the risk of postpartum psychosis.

If you're taking medication, however, you’ll want to work with an experienced team of providers to make adjustments and determine the best way to manage the mental illness throughout the perinatal period. 

Valproate (VPA), for example, is considered one of the most effective treatments for bipolar disorder, but is one of the most harmful to fetal and child development, which is why women of child-bearing age may be advised to take birth control while on VPA or consider alternative treatment if planning to become pregnant.

Regardless of the medication you’re taking, stopping treatment or shifting to new medication overnight can also pose risks. 

In women with a bipolar disorder diagnosis, 54.9% were found to have at least one bipolar-spectrum mood episode occurrence during the perinatal period. There are certain risks faced by pregnant women with bipolar disorder, postpartum psychosis being one of them. Other studies have found that pregnant women with bipolar disorder may be more likely to experience a depressive or mixed episode as opposed to a hypomanic or manic.

While bipolar disorder is often diagnosed prior to a pregnancy, it can also present during pregnancy or postpartum, says Lauren Demosthenes, MD, Senior Medical Director at Babyscripts. “It can sometimes be difficult to diagnose if mild, confusing it with depression. A thorough history is important and consultation with a psychiatrist may be needed," she says.

How to Manage Bipolar Disorder During Pregnancy

In order to properly manage bipolar disorder during pregnancy, the risks and benefits need to be properly assessed and this can vary from person to person. Ideally, women will work with a primary care physician, a mental health professional, and an obstetrician-gynecologist (ob-gyn) to determine the right management plan.

“All risks and benefits need to be considered for each unique pregnant person to determine what pharmaceuticals need to be continued and [which ones] can be discontinued,” says Dr. Gersh. 

Some medications like lithium can be taken during pregnancy, Dr. Demosthenes explains, but others like valproic acid should be stopped prior to conceiving because they can cause birth defects like neural tube defects, craniofacial, cardiac, genial, skeletal and limb malformations and impair cognitive development.

Lithium is often underprescribed, but studies have found that the medication poses little risk to a pregnant woman and child and therefore should be considered as a first-line treatment option for pregnant and postpartum women with bipolar disorder.

Kecia Gaither, MD, MPH, MS/MBA,  FACOG, Director of Perinatal Services/Maternal Fetal Medicine at NYC Health + Hospitals/Lincoln in the Bronx, advises cautious use of lithium in pregnancy with regular monitoring and dose adjustments to maintain therapeutic levels. There exists a risk of fetal cardiac anomalies, so she recommends a detailed sonographic survey of anatomy.

Lamotrigine (LTG) and carbamazepine are other options that may be considered, as they offer low risk for teratogenic effects and congenital malformations. It's important to note the following regarding the two medications:

• LTG/Lamictal dosing often has to be adjusted because of the physiologic changes in pregnancy and due to the interactions between estrogen and LTG.
• Carbamazepine poses greater risks and is used less frequently in pregnancy compared to Lamictal. Women already on carbamazepine pre-conception should discuss the risks and benefits and weigh the risk of changing medication in advance of conception (knowing that they should be stable on whichever one they choose to remain on for at least six months before trying to conceive.

Unfortunately, there’s no straightforward treatment option for bipolar disorder during pregnancy. The best thing you can do is work closely with your provider team to monitor symptoms. Dr. Demosthenes recommends working with a psychiatrist to evaluate and manage the blood levels of the drug you're taking during pregnancy and make dose adjustments as needed.

The goal of medication management is to prevent worsening symptoms and relapses in the pregnant woman, while at the same time protecting the unborn child.

Maintain Strong Mental Health During Pregnancy

Prioritizing your mental health during pregnancy is essential. Pregnant women, regardless of their mental health history, face an increased risk of mental illness.

Therapies such as cognitive behavioral therapy (CBT) have been shown to be safe and effective and can help in managing symptoms and maintaining strong mental health.

Working with a therapist to build a foundation of coping strategies is a good first step. In addition, you can instill healthy habits into your daily life, such as the following:

• practicing meditation
• incorporating mental health breaks into your day
• maintaining a healthy diet
• engaging in regular exercise

“The mood fluctuations that come with pregnancy—and sleep changes—may make it more difficult to deal with the mental health condition,” says Dr. Demosthenes, which is why she recommends building a strong support system among family and friends. 

A Word From Verywell

The perinatal and postpartum periods are exceptionally challenging times, no matter if you have a pre-existing mental illness or not and studies have shown that most pregnant women receive an inadequate amount of mental health care.

For those with bipolar disorder or those experiencing mental health concerns, such as anxiety or depression, notify your ob-gyn of these concerns and consult with a mental health professional to make sure you’re getting the care you need.

Pregnancy can impact your sleep, mood, and behavior. If you’re concerned about your symptoms or feel your mental health condition is worsening, notify your doctor immediately so you can evaluate your lifestyle, your mental health condition, and the management of your bipolar disorder.