A Delicate Balance: Pregnancy with Bipolar Disorder

Medically reviewed in February 2020

For most women, discovering you’re pregnant is a time of excitement and joy. For women with bipolar disorder, however, it can also be a scary time, fraught with a unique, potentially dangerous set of risks.

For instance, did you know that women with bipolar disorder are twice as likely to suffer a relapse of bipolar while pregnant, and seven times more likely to need hospitalization for the episode?

And as recently as ten years ago, doctors actually warned women with bipolar disorder not to have children at all.

One study from Northwestern Medicine illustrates how the physiological changes a woman experiences during pregnancy can actually reduce the effectiveness of her bipolar medication, making her more susceptible to manic and depressive episodes both while she’s pregnant and postpartum.

The study, published in the American Journal of Psychiatry, looked at the blood concentrations of the mood-stabilizing drug lamotrigine (Lamictal), and found that its levels dropped due to a woman’s increased metabolism while pregnant. Researchers also found that about half the women in the study had worsening depressive symptoms as their medication levels decreased.

The implications here are vast. Women with bipolar disorder who become pregnant and suffer depressive episodes may not care for themselves at the level required to have a healthy baby.  They have poorer nutrition and are less likely to comply with prenatal care. They often isolate themselves from the support of friends and family. And depression in pregnant women has also been linked lower birth weights and poorer birth outcomes overall.

A delicate balancing act
Pregnant women on medication for bipolar also have to consider the health of their little one, as some medications can pose risks to the baby.

Valproate (Depakote) increases the risk for neural tube birth defects like spina bifida, while lamotrigine and other drugs may cause facial deformities. Sedatives such as lorazepam (Ativan), sometimes used to treat anxiety or insomnia in bipolar, have been linked to birth defects and a type of withdrawal called floppy infant syndrome.

Even though other medications are safer in pregnancy—lithium, for example—women might be tempted to stop their treatment altogether. But that's also risky. And other research has shown that women who forego their bipolar meds between six months before conceiving and twelve weeks after are more than twice as likely to have a recurrence in their bipolar episodes. They also suffer bipolar symptoms through a much larger part of their pregnancy, and women who quit their medications suddenly are especially vulnerable to relapse.

Healthy mommy, healthy baby
So is it even possible to have a safe pregnancy with bipolar disorder?

Yes, but the most important thing for women who are pregnant, as well as new moms, to remember is to continue working with your doctor. Keep the dialogue open. Tell your doctor as soon as you become pregnant—or, even better, before—so you can work together on adjusting your medications and their dosages. And most importantly, never take yourself off of your treatment program without the recommendations of your obstetrician and mental health provider. A healthy mom means a healthy, thriving baby.

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