The period between 18 and 30 years is when many women are diagnosed with bipolar disorder, and a time when many women have children. Having a mental illness is associated with an increased risk of problems related to pregnancy, childbirth and child rearing. These problems can lead to an increased risk of mood episodes. Medication use during pregnancy requires careful consideration of the mother’s risk of relapse against the risk of harm or complications for the developing infant if medication is to be continued. However, there is currently very little evidence regarding the use of medications for bipolar disorder during pregnancy and the postpartum period.

What is the evidence regarding parenthood?

Moderate to low quality evidence suggests the median rate of mood episodes during pregnancy is around 24%, and around 37% in the postpartum period. Most mood episodes were depressive or mixed episodes. Women taking prophylactic medications during pregnancy or over the postpartum period had a lower relapse rates than women who were medication free.

Studies have found a small increased risk of heart defect or lower birth weight in infants exposed to antipsychotics in the womb, and a small increased risk of preterm delivery. Studies also found small effects of increased risk of neuromotor deficits in early childhood with exposure to antipsychotics in the womb. Review authors report that the studies did not routinely adjust for use of other medications or genetic predisposition, which could have accounted for these findings.No association was found between SSRI antidepressant exposure during pregnancy and autism spectrum disorders in the offspring.

November 2021

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Parents with a bipolar disorder may face challenges in accessing and maintaining treatment programs. They may be less likely to seek treatments due to problems finding care for their children, particularly when inpatient care is required, and at short notice. Parents may also find it difficult to properly adhere to treatment programs due to the demands of parenthood.

What is the evidence for treatments for parents with bipolar disorder?

Only one trial specifically included parents with bipolar disorder and found unclear, low quality evidence for any benefit of the Positive Parenting Program (Triple P). Review authors conclude that more research is needed and future interventions should combine different intervention strategies to target multiple areas in a flexible manner.

November 2021

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

What is the evidence for the use of antipsychotics during pregnancy and breastfeeding?

High quality evidence finds a small, increased risk of gestational diabetes mellitus during pregnancy with antipsychotic use (first or second generation).

Moderate quality evidence suggests a small increased risk of heart defect or lower birth weight in infants, and a small increased risk of preterm delivery, but not stillbirth, with exposure to antipsychotics. Lower quality evidence is unsure about the risk of termination or spontaneous abortion, and the size and malformation in infants.

Review authors report that the studies did not routinely adjust for potential confounding factors, such as other medication use.

October 2020

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