Prescribe sleep post partum: monitor bipolar patients during, after pregnancy.(Obstetrics)

TUCSON, ARIZ. -- Bipolar disorder can present an array of challenges during and after pregnancy, with the same influences that can make treatment most urgent also making it most complicated, Dr. Marlene Freeman said at a psychopharmacology conference sponsored by the University of Arizona.

If the pregnancy is unplanned--which may be more common in women with bipolar disorder because of increased impulsive behavior--some women may immediately discontinue medication upon learning of the pregnancy out of fear of harming the baby.

In doing so, those women can throw themselves into a state that could pose even more of a risk to the child, said Dr. Freeman, director of the women's mental health program at the university.

"Very often, a woman will find out she's pregnant and just suddenly discontinue all of her medications." Dr. Freeman said. "This has great significance because the risk of recurrence is much greater if there is a rapid discontinuation of medication."

Risks of problems are even greater in the highly volatile postpartum period, and research has shown that the risk for relapse for women who have bipolar disorder during this time is exceptionally high, she pointed out.

Dr. Freeman cited a retrospective study comparing two groups of women with bipolar disorder--one consisting of pregnant women and the other of nonpregnant women, all of whom had discontinued lithium maintenance therapy. Rates of recurrence were similar for pregnant and nonpregnant women (52% vs. 58%) during the first 40 weeks after lithium discontinuation.

Among those who remained stable during the first 40 weeks, the relapse rate during weeks 41-64 was significantly higher--70%--among the postpartum women, compared with the nonpregnant group, whose average relapse rate was just 24% (Am. J. Psychiatry 157[2]:179-84, 2000).