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Medication during pregnancy and breastfeeding

How is medication for bipolar disorder during pregnancy and breastfeeding important?

Medication use during pregnancy requires careful consideration of the mother’s risk of illness relapse against the risk of harm or complications for the developing infant if medication is to be continued.

What is the evidence for medication use during pregnancy and breastfeeding in women with bipolar disorder?

Moderate quality evidence finds lithium use during pregnancy was associated with small increased risks of any congenital anomaly, cardiac congenital anomalies, and a medium-sized risk of more spontaneous abortion compared to no lithium use. Note that the findings for cardiac congenital anomalies and spontaneous abortion were not significant when lithium use was compared to no lithium use only in bipolar patients (not general population samples). The finding for any congenital anomaly remained in that comparison. There were no increased risk of preterm birth or low birth weight.

Moderate to low quality evidence finds a small increased risk of heart defect or lower birth weight in infants exposed to antipsychotics in utero, and a small increased risk of preterm delivery. There is also a small increased risk of neuromotor deficits in early childhood with exposure to antipsychotics in utero. However, studies did not allow correction for other medications, genetic predisposition, or other confounding effects.

There were no differences in the odds of autism spectrum disorders in the offspring of mothers with SSRI antidepressant exposure during pregnancy compared with mothers with no antidepressant exposure during pregnancy.

Low quality evidence is unsure of the risk of relapse following discontinuation of mood stabilisers during pregnancy. Review authors conclude that for severe conditions of bipolar disorder, close monitoring, support, and prophylactic medication during pregnancy and the postpartum period is recommended. For women with stable bipolar disorder, well-planned and slow discontinuation of mood stabilisers before pregnancy could be commenced. For unplanned pregnancies, slow discontinuation is particularly important. Medication should be re-started soon after delivery, as the risk of postpartum relapse is high.

October 2021

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Last updated at: 5:29 pm, 15th February 2022
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Fact Sheet Technical Commentary
Tags:  Pregnancy

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