So Glad You Asked with Dr. Ruta Nonacs
RESOURCE HUB – BIPOLAR DISORDER AND PREGNANCY
We hope you enjoyed our episode of on Bipolar Disorder and Pregnancy. If you haven’t listened yet, you can find the podcast on Spotify, Apple, or wherever you get your podcasts.
But there’s more…
To supplement the information provided on the podcast, we have created a comprehensive, evidence-based online set of resources for you to explore. The resource hub provides up-to-date, clinically relevant information and resources for both patients and healthcare providers.
Learn More: Bipolar Disorder and Pregnancy
A curated collection of articles, videos, and other resources to help you better understand your situation — so that you can make medically informed decisions
If you have a history of bipolar disorder and are thinking about getting pregnant, careful planning and collaboration with your healthcare providers can help reduce risks and improve outcomes for both you and your baby. Here are important facts to consider:
General Considerations
- About half of all pregnancies are unplanned, making preconception planning especially important for women with bipolar disorder.
- If you are a woman of childbearing age, it’s never too early to talk about pregnancy and to prioritize the use of medications that are safe to use during pregnancy
- Pregnancy and the postpartum period are times of increased risk for recurrent mood episodes, including both depression and mania.
Risk of Relapse During Pregnancy and the Postpartum Period
- Pregnancy relapse
- Risk of relapse is highest during the postpartum period, especially among women with bipolar disorder who stop medication during pregnancy — about 66%, compared to 23% in those who continue medication during pregnancy and into the postpartum period.
- The highest risk of relapse is in the first month after delivery, so extra monitoring and support are recommended during this period.
- Women with bipolar disorder are at increased risk for postpartum psychosis.
Medication Use During Pregnancy
- Medication is often necessary to manage bipolar disorder during pregnancy, but some medications (such as valproic acid/Depakote) are not safe and should be avoided due to the risk of birth defects.
- There is research to support the use of mood stabilizers, including lamotrigine (Lamictal) and atypical antipsychotic medication.
- While lithium does carry some risk, this is an option for some women with bipolar disorder who are planning pregnancy.
- While medications may carry some risk, untreated bipolar disorder during pregnancy can negatively affect both maternal health and fetal development, increasing the risk of complications such as preterm birth and low birth weight.
Other Important Factors
- Sleep deprivation is a common trigger for relapse. Maintaining regular sleep patterns is especially important during pregnancy and after delivery, as severe sleep loss around childbirth can significantly increase the risk of postpartum psychosis.
- Substance use, smoking, and a history of recent hospital admissions or self-harm further increase the risk of relapse during pregnancy.
Collaborative Care
- Collaborative care with your obstetrician, psychiatrist, and support network is crucial for monitoring symptoms and adjusting treatment as needed throughout pregnancy and postpartum period.
- Individualized care is essential to weigh the risks of medication exposure against the risks of untreated illness, as the illness itself can negatively impact pregnancy outcomes.
In summary: Planning ahead, continuing necessary treatment, and working closely with your healthcare team are the best ways to support a healthy pregnancy and postpartum period if you have bipolar disorder. Avoid abrupt changes in medication without medical advice, and prioritize sleep and support during and after pregnancy.
Other Resources:
Perinatal Bipolar Mood Disorders: Postpartum Support International (PSI) provides an overview of bipolar disorder symptoms, risks during pregnancy and postpartum, treatment options, and support resources for pregnant and postpartum individuals.
Bipolar Disorder in the Postnatal Period: COPE (Australia) explains the impact of bipolar disorder on new mothers, the importance of early intervention, hospital care, and ongoing support after discharge.
Bipolar disorder, pregnancy and childbirth – Information for women, partners and families: An informational booklet published by Bipolar UK.
Reliable Evidence-Based Information on Medications: Don’t Just Google
Please note that these resources are not intended to be a substitute for medical advice or care; they are intended to supplement your treatment and to help you make medially informed decisions. Many other sites offer “Safe During Pregnancy” lists of medications; however, these lists are often incomplete and may also include over-simplified or inaccurate information.
Decisions regarding the use of medications should be made in collaboration with your provider.
The MGH Center for Women’s Mental Health: Provides regularly updated, evidence-based information on the reproductive safety of psychiatric medications.
MotherToBaby Fact Sheets: Evidence-based fact sheets for patients about specific medications and their use during pregnancy and breastfeeding (searchable by medication name).
DailyMed: Provides the most up-to-date drug labeling (package inserts) for prescription and nonprescription drugs. The database includes FDA-approved prescribing information, indications, dosage, warnings, adverse reactions, drug interactions, and use during pregnancy and breastfeeding.
The MGH Center for Women’s Mental Health provides detailed, clinically focused articles on the use of mood stabilizers during pregnancy, including lithium, lamotrigine, and valproic acid.
Mind (UK) – Lithium and other mood stabilisers: A patient-friendly guide specifically on mood stabilisers in pregnancy, covering lithium, lamotrigine, and valproic acid. The page discusses risks, alternative options, and practical advice for planning pregnancy or breastfeeding while on these medications
Hennepin Healthcare – Mood Stabilizers and Pregnancy: This slide presentation from Hennepin Healthcare provides a concise, evidence-based summary of the treatment of bipolar disorder during pregnancy for clinicians and patients.
Royal College of Psychiatrists – Antipsychotics in Pregnancy and Breastfeeding: Offers practical advice on medication choices, risks, and planning for pregnancy. Includes information about perinatal psychiatrists and pregnancy planning.
Mind (UK) – Antipsychotics in Pregnancy: A patient-friendly guide explaining risks and benefits, what to expect if taking antipsychotics during pregnancy or breastfeeding, and how to talk to your healthcare team. This site also has a page on Lithium and Other Mood Stabilizers.
When making treatment decisions during pregnancy, it is essential to weigh not only the potential risks of psychiatric medications but also the significant risks associated with untreated psychiatric illness in the mother. Untreated mood and anxiety disorders can have profound effects on both maternal and fetal health. For mothers, untreated illness may lead to impaired self-care, poor nutrition, increased substance use, and inadequate prenatal care, all of which can negatively impact pregnancy outcomes. There is also a higher risk of pregnancy complications such as pre-eclampsia and operative delivery,
The Policy Center for Maternal Mental Health provides a fact sheet outlining the risks of untreated maternal mental health disorders, including their impact on pregnancy outcomes and early childhood development.
For women with bipolar disorder considering pregnancy or navigating the perinatal period, decisions about medication management require careful consideration of risks, benefits, and personal values. This process is deeply individual and should never be undertaken alone. Below, we expand on strategies for assembling a support system and accessing specialized resources to guide these complex decisions.
Effective care during pregnancy begins with a collaborative team of professionals who specialize in perinatal mental health.
Your psychiatrist or another qualified prescriber should serve as the cornerstone of this team, providing expertise on the use of medications during pregnancy. Throughout the pregnancy and postpartum period, your prescriber will help you to monitor your symptoms and help you to make treatment changes, if needed. Even if you decide to stop your medications, having regular visits with a psychiatrist can help you to stay on track and to identify any problems early.
To help you find a knowledgeable prescriber, Postpartum Support International (1-800-944-4773) provides a directory of providers with expertise in perinatal mental health.
Your obstetrician will closely monitor your pregnancy and, when necessary, collaborate with your psychiatric prescriber to ensure coordinated care. Throughout your pregnancy, your OB will arrange for the appropriate tests and monitoring to safeguard both your health and your baby’s well-being. Unless complications or specific medical concerns arise, most women taking psychotropic medications do not require follow-up with a high-risk or maternal-fetal medicine specialist.
Therapists may provide additional monitoring of your mental health and may help to identify early signs or symptoms of relapse. In addition, they may teach you coping strategies for stress management or offer specialized interventions, including cognitive-behavioral therapy (CBT), to manage depression, anxiety and sleep problems.
Sometimes things don’t work out with the healthcare providers you have chosen. They may be highly regarded by others, but if it doesn’t feel like a good fit for you, it’s OK to seek a second opinion. You should consider seeking out a different provider if you feel that your provider is not listening to or is dismissive of your concerns.
While medical professionals provide clinical guidance, personal support systems offer emotional scaffolding. Partners, family members, and friends can:
- Serve as a sounding board and help you to make decisions regarding your care during pregnancy and the postpartum period.
- Attend medical appointments to help you to communicate concerns and understand complex clinical information.
- Track early warning signs of mood shifts, such as decreased sleep or racing thoughts.
- Share nighttime newborn care to lessen sleep deprivation, a key trigger for relapse.
However, familial relationships are complicated; some women with bipolar disorder report that unsupportive family dynamics exacerbate stress during pregnancy and the postpartum period. In these cases, trusted friends or community organizations can help to fill in the gaps.
Guidance for Family Members: The International Center for Bipolar Disorders has created this information sheet to help family members know how to best support moms during the perinatal period.
Online communities bridge the isolation often felt when making medication decisions about pregnancy and navigating the perinatal period.
- The International Bipolar Foundation and Postpartum Support International (PSI) jointly offer a Bipolar-Specific Perinatal Group: These peer-led sessions connecting participants from pregnancy through two years postpartum.
- The Depression and Bipolar Support Alliance (DBSA) supplements these offerings with identity-focused groups, including sessions for LGBTQ+ parents and rural residents.
Where to Turn for Support and Professional Care
Helping you to connect with trusted and reliable resources, so you don’t have to navigate alone
- Call 911 if you are in an immediate crisis, e.g., in imminent danger of harm to self, others, or have overdosed.
- 988 is the Suicide and Crisis Lifeline.
- The National Maternal Mental Health Hotline 1-833-TLC-MAMA (1-833-852-6262): For non-crisis specialized perinatal mental health support and resources. The National Maternal Mental Health Hotline is available 24/7, in English and Spanish, and 60 other languages by request.
- The Postpartum Support International Helpline 800-944-4773 is a warmline that connects callers with support volunteers and PSI resources
This is a good place to start when you are looking for help because you already have a relationship with that provider and your OB is likely to be connected to providers and other resources in your community. The obstetric service may have mental health professionals who provide services in their office. The hospital may also offer support groups for expecting and new moms. Some OBs are also comfortable prescribing medications for perinatal mood and anxiety disorders.
Psychotherapy can be provided by licensed mental health professionals, including psychologists, licensed clinical social workers (LCSWs), licensed professional counselors (LPCs), and psychiatrists who specialize in therapy. It is important to look for professionals with experience in perinatal mental health to ensure specialized care. In some cases, OBs may also prescribe medications for perinatal mood and anxiety disorders. Some of these providers may have a Perinatal Mental Health Certificate (PMH-C); however, there are many excellent providers who have experience in the treatment of perinatal mental health issues who do not have this certification.
- Postpartum Support International maintains an online directory of qualified perinatal mental health professionals in the US, Canada, and Australia.
- Psychology Today also maintains a list of mental health providers available for in-person or telehealth visits.
Psychiatrists, nurse practitioners, and physician assistants have the authority to prescribe medication; their prescribing rights vary by state. Some of these providers may have a Perinatal Mental Health Certificate (PMH-C); however, there are many excellent providers who have experience in the treatment of perinatal mental health issues who do not have this certification
- Postpartum Support International maintains an online directory of qualified perinatal mental health professionals in the US, Canada, and Australia.
- Psychology Today also maintains a list of mental health providers available for in-person or telehealth visits.
Support may come from many different places, including family, friends, neighbors, other moms, and your community. Support groups, whether in-person or virtual can be immensely helpful in decreasing the isolation many moms feel and can help moms learn about other resources and to connect with their community. There are also specialized groups that support women with specific backgrounds or needs.
- Postpartum Support International offers over 50+ FREE and virtual support groups led by trained peer facilitators. Many of these groups cater to specific populations, for example military moms or individuals with fertility challenges
- Your local hospital may also offer support groups
- Postpartum Support International volunteer coordinators can help you find support resources in your community
- Postpartum Support International also offers a Peer Mentor Program that pairs individuals in need of support with a trained volunteer who has also experienced and has recovered from a perinatal mood or anxiety disorder
Deep Dive: Recent Research and Clinical Insights on Pregnancy and Bipolar Disorder
For you and your providers, evidence-based perspectives and expert opinions to deepen your understanding and inform your care
What Screening Tools Identify Postpartum Women with Bipolar Disorder?
MCPAP for Moms offers an Obstetric Provider Toolkit which includes an array of screening tools including the Bipolar Disorder Screen
Indirect psychiatric consultation for perinatal bipolar disorder: A scoping review.
Hennepin Healthcare – Mood Stabilizers and Pregnancy: This slide presentation from Hennepin Healthcare provides a concise, evidence-based summary of the treatment of bipolar disorder during pregnancy for clinicians and patients.
Striking the Balance: Bipolar Disorder in the Perinatal Period.
Psychotropic drug use in perinatal women with bipolar disorder.
The National Pregnancy Registry for Psychiatric Medications is dedicated to evaluating the safety of psychiatric medications such as antidepressants, ADHD medications, and atypical antipsychotics that many people take during pregnancy to treat a wide range of mood, anxiety, executive function, or psychiatric disorders. The goal of this Registry is to gather information on the safety of these medications during pregnancy, as current data is limited.
If you are pregnant and have taken an antidepressant, ADHD medication, or atypical antipsychotic, please click the participation information button above. Individuals with a history of psychiatric illness who are pregnant and have not taken an antidepressant, ADHD medication, or atypical antipsychotic are also welcome to enroll in the Registry.
TO PARTICIPATE CALL TOLL-FREE: 1-866-961-2388
All pregnant people 45 and younger with a history of psychiatric illness are eligible to enroll in the registry. If you are interested in participating in the National Pregnancy Registry, please call the toll-free number above or fill out this Participant Interest Form to be contacted by a member of our research team. All information is kept strictly confidential.