Bipolar disorder in pregnancy
To read the Introducton to Pregnancy Click Here
- Bipolar disorder can present for the first time in pregnancy or after delivery.
- It can be a pre-existing condition which will need careful monitoring in pregnancy and after delivery.
- Medication taken for bipolar disorder needs to be very carefully monitored in pregnancy and after delivery.
- If a woman gets unexpectedly pregnant on medication, it is important to see her doctor as soon as possible.
- It is important not to suddenly stop medication.
- This medication can have serious effects on the developing baby. It is important for those women on medication to see their doctor prior to pregnancy to plan the best medication and dose for them. (See Medications )
- Specialist psychiatric care is often needed.
- Those women with a family history of bipolar disorder need to be closely monitored during pregnancy and after delivery to watch for either the development of bipolar disorder or depression.
Jackie had bipolar disorder with manic episodes which resulted in two admissions to hospital. One of these admissions occurred when she tried to stop her medication to try and get pregnant. For this reason, Jackie knew that she would have to remain on medication to conceive. She saw a psychiatrist to plan her options for a healthy pregnancy for her and her baby.
Jackie’s plan was to remain on the lowest dose of her medication while she was trying to conceive. This took longer than expected because of fertility problems.
When she had her first positive pregnancy test, the plan was to reduce her medication down to a low dose. (This was as low as possible in an attempt to reduce the risk of the medication causing any problems to the developing baby but not too low to cause Jackie to get unwell and become manic.)
Jackie had a list of “warning signs” which both she and her husband knew they needed to watch for. If any of these signs appeared it meant they needed to get urgent medical attention. All Jackie’s supports, her midwife, obstetrician and GP were fully informed of these signs. This was all planned at the initial assessment with the psychiatrist, three years before Jackie eventually got pregnant.
When Jackie had her positive pregnancy test, she reduced her medication down as directed and was monitored by her GP. She remained on this dose during her pregnancy and kept very well. Immediately following delivery, her dose was increased and her midwife and obstetrician closely monitored her. Five months after her son was born, her medication was reduced back to her “pre-pregnancy” levels.
Jackie had a healthy baby and had remained well during her pregnancy and in the postnatal period. Her only input from the psychiatric team was in the planning stage. They were in the background for urgent attention or advice if needed.
“I felt very well in pregnancy. I felt all the supports were in place and if anything untoward happened then I knew what the plan was. Leading up to delivery, I felt OK. I had every confidence in my midwife and obstetrician and I didn’t feel anxious. This was important because I ended up having an emergency caesarean section. Again, I felt very well after my son was born. I had excellent supports, which had been planned in advance. My mother stayed for three weeks and my husband had two weeks off work.
My midwife watched me closely for any signs of deterioration and my medication was monitored closely. I kept well and my son successfully breastfed and has been well and healthy.
I hope that my successful story can provide hope for other women with bipolar disorder wanting to get pregnant. I knew how bad things can get after having had 2 admissions to hospital and I didn’t want that to happen again”