Women with bipolar disorder (BD) are at increased risk for adverse pregnancy outcomes, results from a Swedish study show.
Robert Bodén (Uppsala University) and team found that both treated and untreated women with BD were at greater risk for delivery complications and infant morbidity than women without BD.
"Our findings of increased risks for several of the investigated outcomes also in the untreated women suggest that mood stabilising treatment is probably not the sole reason for the increased risk of adverse pregnancy and birth outcomes previously observed in women with bipolar disorder," write the authors in the BMJ.
The team studied data on 332,137 women who gave birth between 2005 and 2009 in Sweden. Pregnancy and birth outcomes were compared between 874 women with a diagnosis of BD and 331,263 without such a diagnosis. Of the women with BD, 320 had filled a prescription for mood stabilizers and 554 were untreated.
The researchers found that 37.5% of treated and 30.9% of untreated women with BD had an induced or planned caesarean delivery compared with 20.7% of those without BD.
Furthermore, 8.1% of treated and 7.6% of untreated women with BD gave birth preterm compared with 4.8% of women without BD, and a corresponding 3.3% and 3.9% versus 2.3% had a microcephalic infant.
In addition, a respective 3.4% and 4.3% of infants born to treated and untreated women with BD had neonatal hypoglycemia compared with 2.5% of those born to women without BD.
Bodén et al summarize: "Women with bipolar disorder, regardless of treatment with mood stabilisers, were at an increased risk of adverse pregnancy outcomes."
However, they add that the role of treatment is still unclear as the findings "generally did not support a significant difference between untreated and treated" mothers.
In an accompanying editorial, Salvatore Gentile (ASL Salerno, Cava de' Tirreni, Italy) says: "The question is not 'to treat or not to treat?' but 'how to treat optimally?' Because no drug is without risks, clinicians cannot hope to identify a 'safe choice,' but merely a 'less harmful' one."
He adds that "patients must be properly counselled about the risks of treatment versus the risks associated with the untreated psychiatric disorder."
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