Family planning for women with bipolar disorder
Packer, S.
Hospital and Community Psychiatry 43(5): 479-482
1992
ISSN/ISBN: 0022-1597 PMID: 1587511 DOI: 10.1176/ps.43.5.479Document Number: 326082
The familial transmission risk of developing bipolar disorder for first=degree relatives of the patient is 1.5-10.2%, however, the risk of any affective primary disorder is 15-20% in such relatives. Pregnancy places additional stress on patients, and physiological changes are particularly acute during postpartum. The risk of abnormalities and teratogenicity from psychotropic drugs is significant: taking of phenothiazines, tricyclic antidepressants, monoamine oxidase inhibitors, benzodiazepines, lithium, valproate, and clonazepam require extreme caution. In 225 pregnancies exposed to lithium in the 1st trimester congenital malformations occurred in 11%. Premature birth and macrosomia may also increase, thus halting lithium well before planned conception with weekly serum monitoring is advised. Recurrence of the illness can be managed by electroconvulsive therapy. About 40% of patients can experience postpartum mania or depression. Taking drugs up to delivery can result in behavioral teratogenesis in the neonate even in the absence of physical malformations. Lithium toxicity causes lethargy, hypotonia, tachycardia, coma, cyanosis, and chronic twitching in the newborn. Breast feeding is discouraged in women taking lithium because of the high rate of transmission to the infant. The stress of parenting can also trigger relapses of the disease. The deleterious effect of a manic or depressive mother on the child's development is manifested in criticism and stressing achievement often leads to low self-esteem. It behooves the psychiatrist to frankly reveal the risks of pregnancy to couples who wish to have a child or to advise about the pregnancy to term so they can make an informed decision.