Managing bipolar disorder during pregnancy: weighing the risks and benefits.
BACKGROUND
Challenges for the clinical management of bipolar disorder (BD) during pregnancy are multiple and complex and include competing risks to mother and offspring.


METHODS
We reviewed recent research findings on the course of BD during pregnancy and postpartum, as well as reproductive safety data on the major mood stabilizers.


RESULTS
Pregnancy, and especially the postpartum period, are associated with a high risk for recurrence of BD. This risk appears to be limited by mood-stabilizing treatments and markedly increased by the abrupt discontinuation of such treatments. However, drugs used to treat or protect against recurrences of BD vary markedly in teratogenic potential: there are low risks with typical neuroleptics, moderate risks with lithium, higher risks with older anticonvulsants such as valproic acid and carbamazepine, and virtually unknown risks with other newer-generation anticonvulsants and atypical antipsychotics (ATPs).


CONCLUSIONS
Clinical management of BD through pregnancy and postpartum calls for balanced assessments of maternal and fetal risks and benefits.
Viguera
Adele C
AC
Perinatal and Reproductive Psychiatry Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. aviguera@partners.org
Cohen
Lee S
LS
Baldessarini
Ross J
RJ
Nonacs
Ruta
R
D000014:Abnormalities, Drug-Induced / Q000209:etiology*; D018692:Antimanic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001714:Bipolar Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D012008:Recurrence; D012306:Risk
D018692:Antimanic Agents; D014150:Antipsychotic Agents