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By admin | November 12, 2007

Pregnancy is a magical time of every woman’s life. Having bipolar disorder makes the pregnancy harder and future moms to worry a lot. They worry about the medications they’re taking and their impact on child.
Because bipolar disorder emerges during young adulthood and persists throughout the lifespan, women of childbearing age are at risk for this illness. Pregnancy and delivery can influence the symptoms of bipolar disorder: pregnant women or new mothers with bipolar disorder have higher risk of hospital admission and a twofold higher risk for a recurrent episode, compared with those who have not recently delivered a child or are not pregnant.
Women should plan pregnancy very careful in order to minimize the effect of the illness on their unborn child. Experts suggest it is important to avoid sudden changes in medication during pregnancy, because such changes may increase side effects and risks to the fetus, and also increase the risk of relapse of the illness before or after the woman gives birth.

MEDICATIONS AND THEIR POSSIBLE EFFECT

A study published in April 2001 finds that there is a significantly higher risk of major birth defects when one or more drugs such as Depakote or Tegretol are taken during pregnancy.
The decision whether or not to use medications, particularly mood stabilizers, during pregnancy begins with a risk-benefit exercise in which the patient and her family should be fully involved.
The risks of teratogenicity, posed by all the mood stabilizers, should be weighed against the risks of an illness recurrence, suicide and inability to look after self and the unborn child. If the patient’s previous course of illness has been good with low severity of and frequency of episodes, a planned pregnancy without mood stabilizers may be considered, with a gradual discontinuation of medication and a four week medication-free period before conception. Elective use of ECT, neuroleptics and SSRls in the first trimester can pose a lower relative risk to the fetus compared with mood stabilizers.

If any mood stabilizer is being used in the first trimester of pregnancy, consider folic acid supplements with anticonvulsants, and also monitor for teratogenicity using appropriate investigations. Mood stabilizer dose may need to be raised to maintain a therapeutic serum level as the blood and fluid volume increases during pregnancy. It is advisable to gradually discontinue medication, if this is appropriate clinically, about four weeks before delivery. If the mood stabilizer is being continued during delivery, the doses need to be reduced drastically in order to avoid the toxicity caused by decreasing blood and fluid volumes immediately following childbirth
The immediate post-partum period carries with it a greater than 50% risk of recurrence or exacerbation. Hence it is advisable to recommend re-instituting mood stabilizer treatment if this had been discontinued earlier, or ensuring that serum therapeutic levels are achieved and maintained. All mood stabilizers are secreted through breast-milk. There is pooled data to suggest that the medication or metabolites secreted through breast-milk do not pose a significant immediate risk to the newborn.

LITHIUM - YES OR NO?

The relationship between lithium and congenital malformations has been under scrutiny lately by new scientific observations. The assumption used to be, based on an early study of children born to lithium-using mothers, that prenatal disturbances were frequent. The best known side-effect of using lithium during a pregnancy is perhaps a specific heart defect, known as Ebstein’s disease.
Another disadvantage of the use of lithium during pregnancy is the risk of intoxication with the child. For this reason the newborn, immediately after birth, needs to be examined by a children’s doctor or another specialist. Furthermore, lithiumlevels should be examined more frequently during pregnancy. This has to do with changes in the amount of body fluids during pregnancy and birth. It is preferred that the intake of lithium is canceled a few days before giving birth in order to prevent problems for mother and child. The birth should be evoked in order to limit the period without lithium as much as possible. The birth should take place in a hospital. After giving birth, the patient should immediately start taking lithium again. This is vital, because in this period a chance of a relapse is much bigger. Your moods should be checked regularly.

BREASTFEEDING

Women who breastfeed their newborns unwittingly give lithium to their children. The baby receives about half the amount of lithium the mother takes in, as compared to the lithium level in the mother’s blood. However, the child is much more sensitive to lithium. Breastfeeding is not recommended on these grounds. The production of milk with the mother should not be repressed by the intake of medication. Mainly because becoming manic depressive or psychotic is part of the possible adverse effects from these medications. In the case of Tegretol and Depakine, breastfeeding appears to be safe. It even prevents signs of withdrawal in the child.

Topics: Prenatal Care, Family planning/Contraception, Baby's Health, Pregnancy and Childbirth, Women's Health, Parenting |

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