title: Burden of maternal bipolar disorder on at-risk offspring: a controlled study on family planning and maternal care.
abstract: BACKGROUND
  Bipolar disorder (BD) is a highly incapacitating disease typically associated with high rates of familial dysfunction. Despite recent literature suggesting that maternal care is an important environmental factor in the development of behavioral disorders, it is unclear how much maternal care is dysfunctional in BD subjects.
  
  
  OBJECTIVE
  The objective of this study was to characterize maternal care in DSM-IV/SCID diagnosed BD type I subjects compared to healthy controls with (PD) and without (NPD) other psychiatric diagnoses.
  
  
  METHODS
  Thirty-four BD mothers and 106 controls underwent an interview about family planning and maternal care, obstetrical complications, and mother-child interactions. K-SADS-PL questions about violence exposure were used to ascertain domestic violence and physical/sexual abuse.
  
  
  RESULTS
  BD mothers were less likely to have stable unions (45.5%; p<0.01) or to live with the biological father of their children (33.3%; p<0.01), but had higher educational level and higher rates of social security use/retirement. They also had fewer children and used less contraceptive methods than controls. Children of BD women had higher rates of neonatal anoxia, and reported more physical abuse (16.1%; p=0.02) than offspring of NPD mothers. Due to BD mothers' symptoms, 33.3% of offspring suffered physical and/or psychological abuse.
  
  
  CONCLUSIONS
  Post hoc analysis, and the use of questions as a surrogate of symptoms as opposed to validated instruments.
  
  
  CONCLUSIONS
  This is one of few reports confirming that maternal care given by BD women is dysfunctional. BD psychopathology can lead to poor maternal care and both should be considered important environmental risk factors in BD, suggesting that BD psychoeducation should include maternal care orientation.
authors.affiliation: Mood Disorders Unit, Department and Institute of Psychiatry, Clinical Hospital, School of Medicine, University of Sao Paulo, Brazil. dorismoreno@uol.com.br
authors.forename: Doris Hupfeld
authors.initials: DH
authors.lastname: Moreno
authors.forename: Danielle Soares
authors.initials: DS
authors.lastname: Bio
authors.forename: Sandra
authors.initials: S
authors.lastname: Petresco
authors.forename: Denise
authors.initials: D
authors.lastname: Petresco
authors.forename: Elisa Kijner
authors.initials: EK
authors.lastname: Gutt
authors.forename: Márcio Gerhardt
authors.initials: MG
authors.lastname: Soeiro-de-Souza
authors.forename: Ricardo Alberto
authors.initials: RA
authors.lastname: Moreno
mesh_terms: D000293:Adolescent; D000328:Adult; D001714:Bipolar Disorder / Q000523:psychology*; D016022:Case-Control Studies; D002648:Child; D002649:Child Abuse / Q000175:diagnosis / Q000523:psychology; D016241:Child of Impaired Parents / Q000523:psychology*; D005193:Family Planning Services; D005260:Female; D006801:Humans; D009034:Mother-Child Relations; D009035:Mothers / Q000523:psychology*; D016487:Parenting / Q000523:psychology*; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors