Pregnancy with Bipolar Disorder: Understanding and Managing the Journey

Pregnancy is a beautiful journey; it brings a wave of joy and excitement. But individuals struggling with bipolar disorder may feel a terror of “what if?” with the news of pregnancy. Managing bipolar disorder during pregnancy is a difficult journey. There’s the fear of medication harming the child, potential relapses, and the struggle to maintain stability amidst the hormonal chaos. The complications associated with the condition need careful management; it’s best to inform your doctor and healthcare providers immediately and follow their instructions sincerely. 

Understanding Bipolar Disorder 

Bipolar disorder is a mental health condition that causes significant shifts in a person’s mood, energy levels, and activity patterns. Extreme mood swings are called episodes that can disrupt daily life. Individuals with this disorder typically experience manic or hypomanic episodes and depressive episodes. Each individual gets affected differently, and the intensity or frequency of episodes varies. There is no cure, but effective treatment can help manage the symptoms.  

The Impact of Bipolar Disorder on Pregnancy 

Medication used to manage the symptoms of bipolar disorder can pose risks during pregnancy. Women with the disorder can experience adverse outcomes like gestational hypertension, which is an increase in blood pressure. The occurrence of antepartum hemorrhage rate becomes more frequent, which is the bleeding post-childbirth. Women getting mood stabilizers during pregnancy might increase the risk of giving birth to a child with congenital abnormalities.  

Complications Associated with Bipolar Disorder in Pregnancy 

Treatments provided to help manage the symptoms of bipolar disorder may lead to various complications during pregnancy. It’s best to consult with a perinatal psychiatrist who can review your history and discuss whether prophylactic medicine to avoid relapse is required.  

Increased Risk of Relapse 

Pregnant women with bipolar disorder are more likely to experience mood episodes than those who are not pregnant. The rate of relapse can be as high as 70%, with a significant portion occurring in the first trimester. Women discontinuing medication due to fear of fetal development can significantly increase the risk of relapse. During pregnancy, a woman goes through intense hormonal changes that can trigger mood episodes in her. Increased stress during pregnancy can lead to mood swings.  

Medication Risks and Adjustments 

Mood stabilizers are crucial to managing the episodes of bipolar disorder, but some medications can pose potential risks during pregnancy. Discontinuing medicines can lead to various complications and impact the health of both the mother and child. Valproate, while effective for bipolar symptoms, increases the risk of neural tube defects and heart malformations. Consultation with a doctor will help weigh the risks and benefits of medication and adjust accordingly. Some may suggest alternative therapies, like psychotherapy.  

Postpartum Psychosis 

A woman may experience postpartum psychosis after childbirth. It is a severe mental health condition that causes sudden and dramatic changes in the mental state. The symptoms include delusions, hallucinations, confusion, paranoia, mood swings, and difficulty sleeping. Having bipolar disorder increases the risk of postpartum psychosis, as the disorder involves intense mood fluctuations and changes in brain chemistry.  

Valproate (VPA) and Fetal Development Risks 

Valproate (VPA) is an effective medication for bipolar disorder treatment. Using VPA during pregnancy increases the risk of birth defects in the child. Women using the drug have a higher chance of having a child with neural tube defects, cleft lip, cardiovascular abnormalities, limb defects, and autism. The defect appears to be higher if consumed during the first trimester.  

Mood Episode Occurrences During the Perinatal Period 

Women with bipolar disorder are more likely to experience mood episodes during perinatal phases. Among women with BD, 54.9% experienced one mood episode during this period. Depression rates are as high as 46% in women with bipolar disorder II during their first pregnancy. Hormonal fluctuations, the stress of childbirth and parenting, and sleep deprivation increase the risk of episodes.  

Treatment Options During Pregnancy 

Managing bipolar disorder during pregnancy requires careful consideration due to the potential risks associated with the disorder. There are resources and treatment options available to help a woman manage the symptoms and continue with her pregnancy. It’s crucial to work closely with healthcare providers to develop a personalized plan while prioritizing the health of both. 

Medication Management 

Medication for bipolar disorder during pregnancy can cause severe complications, so it’s essential to consult a mental health specialist before quitting medication. They may ask to continue, stop the drugs, or switch to another option. Consumption of drugs like lithium during the first three months can increase the risk of heart problems in the baby. Lithium can be a safer choice than some antipsychotics, as it can reduce the risk of relapse by 40% when consumed after childbirth. Research suggests that second-generation antipsychotics are relatively safe in pregnancy, which does not necessarily imply causation.  

It is vital to carefully manage the medication during pregnancy so that it can guarantee the safety of the mother and the child. Working together with healthcare providers can help to closely monitor the impact of drugs on the mother and the child and adjust accordingly.  

Non-Medication Therapies 

For some women with bipolar disorder, taking medication can be life-threatening for them and their babies. They must turn to non-medication therapies like psychotherapy, CBT, etc.  

Psychotherapy 

Psychotherapy is an umbrella term for various therapies, like CBT. They equip a woman with techniques like identifying and challenging negative thought patterns that can contribute to mood swings. They also teach relaxation techniques to manage and maintain emotional balance. Therapy teaches how your bipolar disorder impacts your pregnancy.  

Counseling 

During pregnancy, a woman goes through a wide range of emotions, both positive and negative. A counseling session can provide them with a safe space to explore their feelings and develop healthy ways to process them. They also teach strategies for managing mood swings and develop healthy coping mechanisms to deal with common triggers during pregnancy.  

Cognitive Behavioral Therapy (CBT) 

CBT helps women identify triggers for mood swings, such as stress or hormonal fluctuations and teaches them techniques like relaxation exercises, mindfulness, and communication skills to manage difficult emotions and prevent episodes. CBT emphasizes healthy habits like sleep hygiene, exercise, and a balanced diet that help manage overall well-being during pregnancy. It reduces dependency on medication while providing tools to manage anxiety and depression. CBT is a non-invasive and evidence-based therapy approach that provides effective treatment.  

Electroconvulsive Therapy (ECT) 

This is a treatment approach that sends shockwaves through the brain to stabilize mood disorders. It is an effective and rapid treatment option that is safe for some women during pregnancy. During this therapy, there can be a few complications. To avoid issues, the doctor constantly monitors the heart rate and oxygen levels of the baby. Also, suggest intubation to reduce the risk of gastric issues and ask you to follow a healthy diet with plenty of water to prevent premature contractions.  

Mindfulness and Relaxation Techniques 

Mindful activities cultivate present-moment awareness, which helps you acknowledge your emotions without judgment. This also helps you to identify early signs of mood swings and take proactive steps to manage them. Relaxation techniques foster calmness during pregnancy. A few techniques include deep breathing, guided meditation, and progressive muscle relaxation.  

Lifestyle Modifications 

With medication, lifestyle changes can significantly improve mood stability and well-being throughout pregnancy. Following a sleep routine, a healthy and nutritional diet, and regular exercise can aid in maintaining overall well-being. Consult with your doctor before starting a diet or exercising during pregnancy. Implementing relaxation techniques or mindfulness exercises can be effective in managing stress.   

Manage Episodes of Depression and Mania 

Managing episodes during pregnancy requires a collaborative effort between you and your mental health professional. Seeking professional help can help you establish a stable mood state and review your medications to ensure a safe pregnancy. Regular appointments are important to monitor mood swings and discuss any new problematic symptoms.  

Planning for Pregnancy with Bipolar Disorder 

Pre-planning a pregnancy with bipolar disorder is crucial to minimizing the complications for the mother and child. A plan to limit morbidity from active psychiatric illness. Early discussion before conceiving can help a bipolar patient smoothly transition from one treatment to another. 

Preconception Counseling 

Consultation with a counselor and a doctor before conception is required to decide if the individual will need medication during and before the pregnancy. If the woman is stable, then discontinuation of mood stabilizers is recommended before conception. However, abrupt discontinuation increases the risk of relapse. Preplanning and trialing medication allow the doctor and patient to evaluate the response and plan accordingly. Gradually reducing or optimizing medication will make the pregnancy significantly easier with fewer complications.  

Adjusting Treatment Plans 

Bipolar disorder is a severe mental health condition that requires life-long treatment and medication management. When trying to conceive while struggling with bipolar disorder, it is crucial to have a detailed examination of your mental state. Every individual experiences a different level of mania and depressive episodes. A tailored plan identifies safe and equally effective alternatives to maintain mood stability throughout pregnancy. It helps by addressing any current challenges and mitigating any potential risks.  

How to Manage Bipolar Disorder Throughout Pregnancy 

To avoid potential risks related to bipolar disorder, one must work closely with a team of medical professionals to manage the condition. By assessing available data, an effective and safe treatment program needs to be devised to manage bipolar disorder during pregnancy.  

Early Consultation with Healthcare Providers 

With early consultation with healthcare providers, an individual can create a calmer, healthier environment for both the mother and the child. Planning for pregnancy well in advance allows the doctor to assess the individual’s current medication regimen and develop a personalized treatment plan. They can help patients with bipolar disorder achieve a stable mood before conception, reducing the risk of relapse.  

Medication Review and Adjustments 

A review and potential adjustment to the medication used to manage bipolar disorder is required as some medications can damage the developing fetus. Harmful side effects can be managed by reviewing the potential risks of medication and finding safer alternatives. Adjustments are necessary to ensure the continuation of effective management of bipolar disorder. 

Monitoring for Mood Changes 

Fluctuating moods can lead to manic or depressive episodes, and during pregnancy, hormonal changes and stress can contribute to the disorder. Recognizing mood swings allows for early intervention and prevention of episodes. Monitoring fluctuation in moods can inform adjustments to treatment plans and develop proactive strategies to ensure overall well-being.  

Building a Support System 

A robust support system that includes healthcare professionals and your loved ones can be a powerful tool for navigating bipolar disorder throughout pregnancy. A doctor can identify potential risks and adjust medication accordingly. Regular therapy sessions can address anxieties and manage your mental and emotional state. Involving friends and family can offer emotional support and help with daily tasks. Support groups can also aid in managing emotions.  

Develop Your Mental Health Care Plan for Pregnancy and Beyond 

A proactive mental healthcare plan can help in managing the condition and foster a healthy, fulfilling pregnancy. Discussing bipolar disorder, pregnancy plans, and any concerns can significantly reduce any complications. A doctor can review medication and schedule regular therapy sessions to identify triggers and develop effective alternatives to manage the condition. This will also help in postpartum support by continuous monitoring and ongoing support.  

From Pregnancy to Parenthood: Ongoing Support for Bipolar Disorder at Cadabams 

Bipolar disorder generally affects women in their proactive years. Conceiving while struggling with bipolar disorder is possible. You just need the proper support and guidance from experts. Cadabams Hospitals offers the best care in the mental healthcare sector and has been helping individuals for over 30 years. Our experts work collaboratively with other healthcare professionals to make your pregnancy journey safer. We leverage evidence-based approaches and holistic treatment methods to manage the symptoms and avoid potential risks to the mother and child. Get in touch with us today. You can call us at +91 97414 76476. You can even email us at info@cadabamshospitals.com. 

FAQ 

1. How is bipolar managed in pregnancy? 

Bipolar disorder can be successfully managed during pregnancy with close monitoring from a team of healthcare professionals, including a psychiatrist, obstetrician, and perinatal mental health specialist. They can develop a personalized treatment plan that minimizes the risk of mood episodes while ensuring the safety of the developing baby.  

2. What is the best mood stabilizer for bipolar in pregnancy? 

There isn’t a single best mood stabilizer for the disorder in pregnancy, but the safest and most effective option depends on your situation. Generally, lithium is considered to be a first-line treatment for the disorder and also a good option during pregnancy. However, close monitoring is important to ensure your baby’s safety.  

3. Can you have a baby if you have bipolar? 

Yes, bipolar disorder doesn’t prevent you from having a baby. However, it’s essential to approach pregnancy with planning and careful management of your bipolar disorder. Pre-pregnancy planning, medication management, and regular therapy are crucial.  

4. What are the risks of bipolar disorder in pregnancy? 

Mental disorders can pose some risks during pregnancy for both the mother and the baby. It can trigger mood swings and increase the risk of high blood pressure and preterm labor. Medication may increase the risk of birth defects for the child. It can also lead to postpartum psychosis.  

5. Can bipolar disorder affect my baby after birth? 

It can impact mother-infant bonding as there is a risk of manic or depressive episodes that can be challenging to fully engage in caring for a newborn. It also increases the risk of postpartum mood disorders leading to depression or psychosis.