title: Risk of Postpartum Relapse in Bipolar Disorder and Postpartum Psychosis: A Systematic Review and Meta-Analysis.
abstract: OBJECTIVE
  Women with a history of bipolar disorder, postpartum psychosis, or both are at high risk for postpartum relapse. The aim of this meta-analysis was to estimate the risk of postpartum relapse in these three patient groups.
  
  
  METHODS
  A systematic literature search was conducted in all public medical electronic databases, adhering to the PRISMA guidelines. Studies were included if they reported postpartum relapse in patients diagnosed with bipolar disorder and/or a history of postpartum psychosis or mania according to DSM or ICD criteria or the Research Diagnostic Criteria.
  
  
  RESULTS
  Thirty-seven articles describing 5,700 deliveries in 4,023 patients were included in the quantitative analyses. The overall postpartum relapse risk was 35% (95% CI=29, 41). Patients with bipolar disorder were significantly less likely to experience severe episodes postpartum (17%, 95% CI=13, 21) than patients with a history of postpartum psychosis (29%, 95% CI=20, 41). Insufficient information was available to determine relapse rates for patients with bipolar disorder and a history of postpartum episodes. In women with bipolar disorder, postpartum relapse rates were significantly higher among those who were medication free during pregnancy (66%, 95% CI=57, 75) than those who used prophylactic medication (23%, 95% CI=14, 37).
  
  
  CONCLUSIONS
  One-third of women at high risk experience a postpartum relapse. In women with bipolar disorder, continuation of prophylactic medication during pregnancy appears highly protective for maintaining mood stability postpartum. In women with a history of isolated postpartum psychosis, initiation of prophylaxis immediately after delivery offers the opportunity to minimize the risk of relapse while avoiding in utero medication exposure.
authors.affiliation: From the Department of Psychiatry, Erasmus Medical Centre, Rotterdam, the Netherlands; the National Center for Register-Based Research, University of Aarhus, Aarhus, Denmark; and the Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands.
authors.forename: Richard
authors.initials: R
authors.lastname: Wesseloo
authors.affiliation: From the Department of Psychiatry, Erasmus Medical Centre, Rotterdam, the Netherlands; the National Center for Register-Based Research, University of Aarhus, Aarhus, Denmark; and the Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands.
authors.forename: Astrid M
authors.initials: AM
authors.lastname: Kamperman
authors.affiliation: From the Department of Psychiatry, Erasmus Medical Centre, Rotterdam, the Netherlands; the National Center for Register-Based Research, University of Aarhus, Aarhus, Denmark; and the Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands.
authors.forename: Trine
authors.initials: T
authors.lastname: Munk-Olsen
authors.affiliation: From the Department of Psychiatry, Erasmus Medical Centre, Rotterdam, the Netherlands; the National Center for Register-Based Research, University of Aarhus, Aarhus, Denmark; and the Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands.
authors.forename: Victor J M
authors.initials: VJ
authors.lastname: Pop
authors.affiliation: From the Department of Psychiatry, Erasmus Medical Centre, Rotterdam, the Netherlands; the National Center for Register-Based Research, University of Aarhus, Aarhus, Denmark; and the Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands.
authors.forename: Steven A
authors.initials: SA
authors.lastname: Kushner
authors.affiliation: From the Department of Psychiatry, Erasmus Medical Centre, Rotterdam, the Netherlands; the National Center for Register-Based Research, University of Aarhus, Aarhus, Denmark; and the Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands.
authors.forename: Veerle
authors.initials: V
authors.lastname: Bergink
mesh_terms: D014150:Antipsychotic Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy / Q000523:psychology*; D005260:Female; D006801:Humans; D049590:Postpartum Period / Q000523:psychology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000523:psychology*; D011618:Psychotic Disorders / Q000188:drug therapy / Q000523:psychology*; D011644:Puerperal Disorders / Q000523:psychology*; D012008:Recurrence; D012306:Risk; D055502:Secondary Prevention
chemical_list: D014150:Antipsychotic Agents