[Management of women with bipolar disorders from conception through the postpartum period].
Any plans for pregnancy must be discussed in detail with women with bipolar disorders. They must be informed about the risks related to it and the need for some precautions. Because of the risk of relapse during pregnancy, the risk/benefit ratio of maintaining or starting prophylactic treatment should be assessed, taking into account family history and frequency of recurrences. Lithium may be used during pregnancy under close monitoring. Most anticonvulsants are contraindicated because of their teratogenicity. During the post-partum period, prophylaxis is required in most cases because of the high risk of relapse. If no prophylaxis was given during pregnancy, it must be started quickly after delivery to be effective when the risk is at its highest, i.e., during the first two weeks after delivery. Women with bipolar disorders should be advised against breast-feeding to avoid exposure of the infant to psychotropic medication. Because breast-feeding can be stressful and causes sleep deprivation, it may increase the risk of relapse. Second-generation antipsychotic agents should not be used during pregnancy or breast-feeding because inadequate information is currently available about their safety.
Nordon
Clémentine
C
Réseau de Psychiatrie Périnatale, Service Universitaire de Psychiatrie Adulte, Centre Hospitalier Charles Perrens, Bordeaux, France.
Sutter
Anne-Laure
AL
Verdoux
Hélène
H
D000927:Anticonvulsants / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy / Q000517:prevention & control / Q000628:therapy*; D001942:Breast Feeding; D000075202:Contraindications; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D018020:Lithium Compounds / Q000627:therapeutic use; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy / Q000517:prevention & control / Q000628:therapy*; D011644:Puerperal Disorders / Q000188:drug therapy / Q000517:prevention & control / Q000628:therapy*; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors
D000927:Anticonvulsants; D014150:Antipsychotic Agents; D018020:Lithium Compounds