Consistent mania monitoring during perinatal period warranted

By Lucy Piper, Senior medwireNews Reporter

Pregnant and postpartum women with bipolar disorder experience clinically severe symptoms, suggesting the need for continued monitoring of mania during this time, say researchers.

The risk of suicide, substance abuse and impact on the mother–child relationship are of particular concern, notes the team, led by Cynthia Battle (Butler Hospital Psychosocial Research Program, Providence, Rhode Island, USA).

The researchers retrospectively reviewed the medical charts of 334 pregnant and postpartum women, aged an average of 27.8 years, who sought psychiatric care at an interdisciplinary obstetrical hospital.

Of these, 32 (10.2%) were diagnosed with bipolar disorder, including 19 with bipolar I disorder, 10 with bipolar II disorder and five with bipolar disorder not otherwise specified. The remainder were diagnosed with other Axis I conditions.

The researchers note in the Journal of Affective Disorders that, although only 10% were diagnosed with bipolar disorder, about a quarter of the women reported symptoms of elation and over three-quarters reported symptoms of irritability lasting more than 4 days in the past month.

The women with bipolar disorder, compared with those with other Axis I diagnoses, were significantly more likely to have extensive mental health histories, including a higher rate of prior substance use (55.9 vs 26.1%) and a history of pharmacotherapy (90.0 vs 60.6%) and psychotherapy use (93.3 vs 66.1%).

Women with bipolar disorder were also more likely than other women to be taking medication at the time of enrolment, at 64.7% versus 40.7%. This was particularly evident among the 110 pregnant women.

There was a similar rate of suicidal ideation at intake among the women with and without bipolar disorder, but a history of suicidal behaviour and attempts was significantly more common among those with bipolar disorder, at 58.8% versus 26.6%.

And women with bipolar disorder were more likely to report symptoms of irritability and elation, significantly so for the latter, in the month before enrolment.

Among the 224 postpartum women, those with bipolar disorder were more likely to report delivery complications than those without (55.0 vs 26.7%), and although as likely to breastfeed, were more likely to report problems doing so (77.8 vs 42.3%).

Given the complex treatment decisions perinatal women with bipolar disorder face, the researchers say that “[c]ontinued engagement in care during the high risk perinatal transition is essential.”

They conclude: “Patient-centered decision support and development of tailored adjunctive psychotherapies for perinatal [bipolar disorder] may play a key role in helping women with [bipolar disorder] remain engaged in treatment during pregnancy and postpartum.”

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