title: Bipolar Disorder in Pregnancy and Postpartum: Principles of Management.
abstract: Pregnancy and postpartum represent times of increased vulnerability for women with bipolar disorder, yet this condition remains under-diagnosed and under-treated. As 50 % of pregnancies are unplanned, the risks associated with the illness and the potential risks associated with treatment should be considered when a woman of reproductive age first presents for evaluation. This article reviews the epidemiology of perinatal bipolar disorder, screening recommendations, and treatment with pharmacotherapy and electroconvulsive therapy (ECT). An overview of the data in pregnancy and lactation is presented for lithium, lamotrigine, valproic acid, newer antipsychotics, and ECT. General principles of management include close monitoring in pregnancy and postpartum, careful adjustment of the treatment regimen to attenuate the risk of relapse, and avoidance of valproic acid when possible. Thoughtful consideration of these issues will minimize the risks to the mother and baby.
authors.affiliation: Department of Psychiatry, New York University School of Medicine, New York, NY, USA. sabrina.khan@nyumc.org.
authors.forename: Sabrina J
authors.initials: SJ
authors.lastname: Khan
authors.affiliation: Department of Consultation-Liaison Psychiatry, Long Island Jewish Medical Center, New Hyde Park, NY, USA.
authors.forename: Madeleine E
authors.initials: ME
authors.lastname: Fersh
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Carrie
authors.initials: C
authors.lastname: Ernst
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, NY, USA.|Consultation Psychiatry Mount Sinai Health System, New York, NY, USA.|Behavioral Medicine and Consultation Psychiatry, Mount Sinai Medical Center, New York, NY, USA.
authors.forename: Kim
authors.initials: K
authors.lastname: Klipstein
authors.affiliation: Department of Psychiatry, Icahn Medical School at Mount Sinai, New York, NY, USA.
authors.forename: Elizabeth Streicker
authors.initials: ES
authors.lastname: Albertini
authors.affiliation: Psychiatry, Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Shari I
authors.initials: SI
authors.lastname: Lusskin
mesh_terms: D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy*; D004565:Electroconvulsive Therapy; D005260:Female; D006801:Humans; D007774:Lactation; D000077213:Lamotrigine; D018020:Lithium Compounds / Q000627:therapeutic use; D049590:Postpartum Period; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy*; D012306:Risk; D014227:Triazines / Q000627:therapeutic use; D014635:Valproic Acid / Q000627:therapeutic use
chemical_list: D014150:Antipsychotic Agents; D018020:Lithium Compounds; D014227:Triazines; D014635:Valproic Acid; D000077213:Lamotrigine
keywords: Antipsychotics; Bipolar disorder; Depression; Lactation; Mood stabilizers; Neonatal complications; Neurodevelopmental effects; Perinatal; Postpartum; Pregnancy; Teratogenicity