Bipolar disorder in pregnancy
Many women with bipolar disorder have healthy pregnancies and babies, but there are some risks around having a baby with the condition.
If you have bipolar disorder you are at risk of:
- developing postpartum psychosis, particularly if other women in your family have had postpartum psychosis
- developing postnatal depression
- your condition coming back (having a relapse) during your pregnancy if you have had any severe episodes recently and/or need medication to prevent relapse.
How common is it?
About 1 in every 100 adults (men and women) has bipolar disorder at some point in their life.
About 1 in 5 women with bipolar disorder develop a severe case of postpartum psychosis quickly in the first few weeks after having a baby.
If you have bipolar disorder it’s best to talk to your doctor and psychiatrist (if you have one) before you become pregnant. This will help make sure you are on the most appropriate medication for you and your baby and that your condition is stable. Find out more about Bipolar disorder and planning a pregnancy.
How should my condition be managed during my pregnancy?
If you are pregnant tell your GP or midwife that you have bipolar disorder straight away. You should be referred to a specialist mental health service or to the community mental health service.
Do not stop taking medication for mental health problems before talking to your doctor. This can lead to withdrawal symptoms. It could also make your symptoms come back or get worse.
Some medications used to treat bipolar disorder carry risks when you are pregnant or breastfeeding. But some women will still need to take their medication because the benefits of managing their bipolar outweigh any risk to their pregnancy.
Your mental health specialist will talk to you about what may be best for you, but it is your decision. You may be advised to:
- stay on the medication you are on now
- switch to another medication
- stop or reduce the dose of your medication.
Make sure you understand the risks and benefits of all your options before you decide.
Sodium valproate is known to increase the risk of specific birth defects including neural tube defects such as spina bifida. If you are taking valproate speak to your doctor immediately for advice.
Your mental health specialist and midwife will work together to make a care plan for how your condition will be treated during pregnancy, birth and afterwards. This plan should include how you will be treated if you decide to breastfeed and how you will be monitored for relapse after you have the baby. It’s good if you are given a copy of the plan and there should be details how you and your family can get help quickly if you become unwell. You can share this plan with anyone involved in your pregnancy care.
Your specialist may offer cognitive behavioural therapy or other talking therapy to lower the chances of your condition coming back during and after pregnancy. This may be especially helpful if you change or stop taking medication.
If you develop mania or severe depression and you're already taking medication, you need to see your doctor immediately.
Will I be referred to social services?
Social services may want to make sure you have the help you need and that you are OK and that you have support. Try not to get anxious about this. Social services prefer to keep families together and will never take a baby into care just because the mother has a mental health problem. They will only take a baby into care if you and the baby’s dad can’t look after them safely (because of your mental health problem or for any other reason). Find out more.
If you're taking medication for bipolar disorder and you plan to breastfeed, your doctor should make sure that it’s safe to carry on taking your medication. If you are breastfeeding and are taking medication for your condition, your baby should be checked for side effects.
Lithium can go through the mother’s milk, so it isn’t suitable for breastfeeding. But some women with bipolar disorder need to take lithium to stay well. If you’re taking lithium, ask your healthcare professional for more support and information about bottle feeding your baby.
There may be other reasons why breastfeeding is not for you. For example, if you’re not having any sleep because you’re up feeding the baby this can impact your condition. Some mothers decide to formula feed or pump breastmilk so their partner can do the night feeds.
If you decide not to breastfeed to avoid sleep deprivation there’s no need to feel guilty about it. Your baby needs you to be well.
How can I help myself?
- Keep a mood diary so you learn to recognise signs your mood is going out of control. Bipolar UK has one that you can use.
- Use stress management strategies e.g. avoid stressful situations where possible, or use cognitive behavioural therapy to cope with unavoidable stress.
- Talk to your partner or family about how you feel
- Look after yourself. Try some of our top tips for looking after your emotional wellbeing.
- Practise relaxation exercises.
- Don’t take on too much – make time for yourself.
- Eat well and exercise regularly.
- Take your medication, even if you’re feeling fine. Talk to your doctor if you want to stop taking it.
- Try to sleep well.
- Read the NICE guidelines about the management of bipolar disorder.
Have a support network in place
You can’t plan for everything, especially when it comes to being a new parent. But you may find it helpful to talk to family and friends about your condition and what they can do to help you stay well after the baby is born. This may help you feel more prepared and in control.
Make sure your closest friends and family understand your condition and how it affects you. For example, you could talk to them about:
- your main symptoms
- what medication you take
- how to recognise the triggers and signs of an episode of depression or mania
- who they need to contact in case you become unwell.
Friends and family can also provide practical support, such as:
- cooking healthy meals for you
- taking the baby for a walk so you can get some sleep
- doing any household chores for you, such as cleaning or laundry
- spending time entertaining the baby while you take a break – even if it’s just to have a bath or shower.
Make sure your care plan has details of the professionals you can contact if you need extra help after the baby is born. Asking for help if you need it is always a positive step.
More information and support
Royal College of Psychiatrists. Postpartum Psychosis: Severe mental illness after childbirth https://www.rcpsych.ac.uk/healthadvice/problemsdisorders/postpartumpsychosis.aspx (Last reviewed: June 2015 Next review due: June 2018)
Royal College of Psychiatrists. Bipolar disorder https://www.rcpsych.ac.uk/healthadvice/problemsanddisorders/bipolardisorder.aspx (Last reviewed: April 2015 Next review due: April 2018)
Wessello R et al (2016) Risk of Postpartum Relapse in Bipolar Disorder and Postpartum Psychosis: A Systematic Review and Meta-Analysis. The American Journal of Psychiatry 2016 Feb 1;173(2):117-27. doi: 10.1176/appi.ajp.2015.15010124. Epub 2015 Oct 30.
NICE (2013) Antenatal and postnatal mental health: clinical management and service guidance National Institute for Health and Care Excellence
CKS(2017) Bipolar disorder https://cks.nice.org.uk/bipolar-disorder#!scenariorecommendation:7
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