Bipolar disorder and planning a pregnancy
Why is it important to plan my pregnancy?
Most women with bipolar disorder have a healthy pregnancy and baby, but there are some risks to be aware of.
You may become unwell during your pregnancy, but the risk is higher after you give birth. Women with bipolar disorder are more likely to get:
- postnatal depression
- postpartum psychosis, particularly if other women in your family have had postpartum psychosis
Some medicines used to treat bipolar disorder also carry risks for the baby.
It can be difficult to read about these things, but specialist doctors can support you and there are things you can do as well to stay well.
Your doctors can help you make some decisions about how you want to manage your condition during pregnancy. For example, you may want to try a different medication. Ideally, this should be done before you get pregnant.
Do not stop taking your medicine before talking to a doctor. This can lead to withdrawal symptoms, particularly if stopped abruptly, or it could make your symptoms come back or get worse.
Planning for pregnancy before you stop contraception with your healthcare team will help you feel confident that:
- you are on the best medication for you and your baby
- your condition is as stable as possible
- you understand your ‘early warning signs’ of becoming unwell so that you, and those close to you, can watch out for them.
Because it’s impossible to know when you will become pregnant (1 in 4 women get pregnant within a month of stopping contraception), it is important to keep using contraception until you’ve spoken to your doctor about your treatment.
Many pregnancies are not planned. If you are already pregnant, tell your midwife or healthcare team straight away. Do not stop taking medication without talking to them.
Find out more about bipolar disorder during and after pregnancy.
Who do I speak to for advice about getting pregnant with bipolar disorder?
Talk to your GP and psychiatric team and ask to be referred to a perinatal mental health team. These are mental health professionals with a special interest in pregnancy and childbirth. This may not be available in every area.
If there is no local service, it may be possible to see a perinatal psychiatrist further away or there may be a specialist Mood Disorder Service in your area. If these options are not available, you should see a psychiatrist for advice, even if you are not under the care of psychiatric services right now. Ask your doctor about getting a referral.
You will be able to discuss:
- how to make sure you are as well as possible when starting pregnancy
- your risk of developing postpartum psychosis or postnatal depression
- risks and benefits of medication in pregnancy and after birth
- the type of care you can expect in your local area.
Medication for bipolar disorder and planning a pregnancy
Some medicines used to treat bipolar disorder carry risks for the baby.
For example, the anticonvulsants sodium valproate and carbamazepine can increase the risk of birth defects including neural tube defects such as spina bifida and problems with the baby’s mental development (learning difficulties).
Lithium may increase the risk of heart defects and other congenital abnormalities in the baby, though these complications are rare.
For some women, taking these medications will be the only way of managing their condition. In these circumstances, your specialist should talk to you about the risks from taking medication versus the risks for you and your baby becoming ill if you don’t take the it. You can make an informed decision about what is best for you.
You may be advised to:
- stay on your current treatment throughout conception, pregnancy, and birth.
- switch to another treatment.
- stop or reduce the dose of your medication.
Your healthcare professional should explain the risks and benefits of all your options clearly so you and your partner (if you have one) can make an informed decision about your care.
Pregnancy prevention programme
If you are taking sodium valproate the risks to pregnancy are high. But for a small number of women, this is the only treatment that works and stopping it may lead to a serious relapse.
If you are prescribed sodium valproate you should also be enrolled in a Pregnancy Prevention Programme (PPP). This does not mean you can never get pregnant. The programme helps you avoid an unplanned pregnancy by giving you advice on the most effective contraception to avoid the risks of taking sodium valproate in pregnancy.
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. It’s a good idea to 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 relapsing during and after pregnancy. This may be especially helpful if you change or stop taking medication.
How can I help myself?
Planning to have a baby is very exciting, but it can also be very daunting. You’ve probably got a lot on your mind such as money, work and how long it will take to get pregnant. It’s natural to feel a bit anxious about these things, but it’s important to try and keep stress to a minimum.
Taking some time to think about and make plans for how you will cope with pregnancy and a baby can help.
Support from family and friends
Having support from family and friends before, during and after pregnancy is really important, especially if you have a mental health condition. Talk to the people closest to you about how you feel and any concerns you have about pregnancy, being a mum, your illness and how it can affect you. If they understand more about how you’re feeling they can give better support. For example, they could:
- help you with jobs around the house if you’re feeling sick or tired in pregnancy
- do your shopping so you can get some sleep
- go for walks or listen to music with you to help you relax
- reassure you if you’re feeling anxious
- recognise any signs or symptoms that you’re becoming unwell and help you get the professional care you need.
Try to be honest about how you’re feeling with the professionals who are looking after you while you try to get pregnant. Make sure you know what type of care you should be getting and who you can contact in an emergency. It can help if the people closest to you have this information too.
You can also find more information and support from charities such as Bipolar UK and Bipolar Fellowship Scotland.
Taking care of yourself
Here are some simple ways to take care of yourself while trying for a baby.
- Keep a mood diary so you learn to recognise signs your mood is going out of control
- Use stress management strategies, e.g. avoid stressful situations where possible or use cognitive behavioural therapy techniques to cope with unavoidable stress
- Practise relaxation exercises
- Don’t take on too much and make time for yourself
- Eat well and exercise regularly
- Don’t smoke, drink alcohol or take illegal drugs.
- Take folic acid
- Take your medication, even if you’re feeling fine.
- Talk to your doctor about your pregnancy plans before changing or stopping medication.
Find out more about planning a pregnancy and looking after your general mental health and wellbeing while you’re trying.
More information and support
National Centre for Mental Health (2014) Bipolar disorder, pregnancy and childbirth https://www.bipolaruk.org/Handlers/Download.ashx?IDMF=fd8688dc-309e-4afd-8386-1bbef3f814da
NICE (2013) Antenatal and postnatal mental health: clinical management and service guidance National Institute for Health and Care Excellence
Patorno E et al (2017) Lithium use in pregnancy and the risk of cardiac malformations. The New England Journal of Medicine BMJ. 2017 Jun 8;376(23):2245-2254. doi: 10.1056/NEJMoa1612222.
Munk-Olsen et al (2018) Maternal and infant outcomes associated with lithium use in pregnancy: an international collaborative meta-analysis of six cohort studies. Lancet Psychiatry. 2018 Aug;5(8):644-652. doi: 10.1016/S2215-0366(18)30180-9. Epub 2018 Jun 18.
The Faculty of Sexual & Reproductive Healthcare of the Royal College of Obstetricians & Gynaecologists (2018) MHRA requires enrolment in a pregnancy prevention programme during use of sodium valproate. https://www.fsrh.org/news/mhra-prescription-valproate-pregnancy-contraception/