Postpartum Relapse in Patients with Bipolar Disorder

Abstract

Pregnancy and postpartum are vital times of greater vulnerability to suffer a decompensation of bipolar disorder (BD). Methods: A systematic literature search was performed on public electronic medical databases, following PRISMA guidelines. Studies were included if they reported postpartum relapse in patients diagnosed with BD according to Diagnosis Statistical Manual (DSM) or International Classification Disease (ICD) criteria. Results: Sixteen articles describing 6064 deliveries of 3977 women were included in the quantitative analyses. The overall risk of postpartum relapse was 36.77%. The methodology of the studies, the diagnostic criteria, the discrimination between BD type I and II, and the origin of the sample were very heterogeneous. Conclusions: the rate of postpartum bipolar relapse is very high, as it is considered to be a critical period. It is especially important to detect decompensation in this period and to evaluate mood-stabilizing treatment, given the high risk of relapse concentrated in a short period.

Occurrence of postpartum manic or mixed episodes in women with bipolar I disorder: A systematic review and meta‐analysis

“…Another systematic review found a relapse risk of 36.7% in 3977 women with 6064 deliveries. 5 Finally, a recent systematic review and meta-analysis estimated that 54.9% (95% CI, 39.2-70.2) of women with pre-existing illness had at least one bipolar-spectrum mood episode during pregnancy or 1 month postpartum. 6 Depression is the most common condition postpartum in studies considering all types of bipolar disorder, 5 however, studies reporting the specific types of bipolar disorder have found a greater prevalence of mania or postpartum psychosis.…”

“…5 Finally, a recent systematic review and meta-analysis estimated that 54.9% (95% CI, 39.2-70.2) of women with pre-existing illness had at least one bipolar-spectrum mood episode during pregnancy or 1 month postpartum. 6 Depression is the most common condition postpartum in studies considering all types of bipolar disorder, 5 however, studies reporting the specific types of bipolar disorder have found a greater prevalence of mania or postpartum psychosis. 5,[7][8][9][10] With the publication of its fourth edition in 1994, the Diagnostic and Statistical Manual first acknowledged the heightened risk of manic, mixed, and depressive episodes after delivery.…”

Pregnancy intention in relation to maternal and neonatal outcomes in women with versus without psychiatric diagnoses

“…First and foremost, the perinatal period can negatively impact maternal mental health. [1][2][3] Women with previous psychiatric disorders such as psychotic, bipolar, and depressive disorders have a considerable risk of relapse in the peripartum period. 1,2,4,5 Moreover, studies also established severe maternal and neonatal adverse consequences.…”

“…[1][2][3] Women with previous psychiatric disorders such as psychotic, bipolar, and depressive disorders have a considerable risk of relapse in the peripartum period. 1,2,4,5 Moreover, studies also established severe maternal and neonatal adverse consequences. [6][7][8] Mothers with psychiatric disorders are at higher risk of admission to an intensive care unit, unplanned cesarean section, gestational diabetes, preeclampsia, induced labor, and have lower rates of breastfeeding.…”

“…The perinatal period is a vulnerable period for women with psychiatric diagnoses and their offspring. First and foremost, the perinatal period can negatively impact maternal mental health 1–3 . Women with previous psychiatric disorders such as psychotic, bipolar, and depressive disorders have a considerable risk of relapse in the peripartum period 1,2,4,5 .…”