Protective effect of pregnancy in women with lithium-responsive bipolar disorder

Grof, Paul; Robbins, Wendy; Alda, Martin; Berghoefer, Anne; Vojtechovsky, M; Nilsson, Agneta; Robertson, Carrie

doi:10.1016/s0165-0327(99)00197-4

Cited by 116 publications

(84 citation statements)

References 30 publications

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“…There is a clinical lore about the protective effect of pregnancy against the recurrence of mood disorders. Several recently published reports suggest that women with lithium-responsive BD had experienced fewer mood episodes during pregnancy [4]. In another study, rates of relapse were similar in pregnant and nonpregnant bipolar women [5].…”

Section: Introductionmentioning

confidence: 86%

Risk Factors Associated with Childbearing-Related Episodes in Women with Bipolar Disorder

et al. 2003

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Objective: For the onset of illness and possible recurrence during the childbearing period, women with bipolar disorder (BD) are at a higher risk. The aim of this study was to evaluate the impact of clinical and psychosocial factors associated with pregnancy and the postpartum period on the course of BD. Methods: The childbearing and illness history of 72 women with BD were assessed to determine mood episodes related to the childbearing period. Data was analyzed to evaluate the risk factors (clinical, obstetric and psychosocial factors) related with mood episodes during pregnancy and the postpartum period. Results: Data of 252 pregnancies and childbirths of 72 women with BD were included in the analysis. Twenty-three (32%) women with BD reported at least one mood episode during pregnancy or within 1 month after childbirth (childbearing-related episode, CBRE). Subjects with CBREs mean age at onset of illness and mean age at the time of assessment were significantly younger than subjects with N-CBRE. A lower number of women who experienced a postpartum episode after the birth of the first child chose to have the second one. Psychosocial factors during pregnancy and the postpartum period and method of delivery did not predict the first postpartum episode. Onset of illness at an early age, experiencing episode during the first pregnancy and experiencing physical problems during pregnancy predicted a mood episode during the first postpartum period. Conclusions: Interpretation of the results of the study is limited with the retrospective nature of data collection. Within the limitations, we may suggest that psychosocial factors do not play a significant role in the genesis of CBREs in women with BD.

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Section: Introductionmentioning

confidence: 86%

Risk Factors Associated with Childbearing-Related Episodes in Women with Bipolar Disorder

et al. 2003

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“…When studying the effect of pregnancy on the course of bipolar illness [73] , we were surprised at the large proportion of affected women who actually had complied and avoided becoming pregnant.…”

Section: Second Generation Of Respondersmentioning

confidence: 99%

Sixty Years of Lithium Responders

Grof¹

2010

Neuropsychobiology

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It has been 60 years since Cade first described patients who responded to antimanic lithium treatment. Two decades later, responders to lithium stabilization emerged in larger numbers. The responses of many severely ill bipolar patients to lithium were striking and called for an explanation. Remarkable reactions to a simple ion generated hope for an uncomplicated laboratory test of response and an extensive search for suitable biological markers ensued. But despite promising reports, particularly from molecular genetics, we are still waiting for a biological elucidation of the stabilizing effects of lithium. The most useful predictor of lithium stabilization has to date been the patient’s clinical profile, based on a comprehensive clinical assessment: complete remissions and other characteristics of episodic clinical course, bipolar family history, low psychiatric comorbidity and a characteristic presenting psychopathology. In brief, the responders approximate the classical Kraepelinian description of a manic-depressive patient. But the most intriguing findings have recently emerged from prospective observations of the next generation: the children of lithium responders, their counterparts coming from parents who did not respond to lithium and controls. Overall, they indicate that parents and offspring suffer from a comparable brain dysfunction that manifests clinically in distinct stages. If the child’s predicament starts early in childhood, it presents with varied, nonaffective or subclinical manifestations that are usually nonresponsive to standard treatments prescribed according to the symptoms. The next stage then unfolds in adolescence, first with depressive and later with activated episodes. The observations have a potential to markedly enrich the prevailing understanding and management of mood disorders.

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“…Grof and colleagues recently suggested that pregnancy has an apparent protective effect on the course of lithium-responsive BD I (with mania) (24). They describe a benign course and even improvement during pregnancy, based on comparisons before and after pregnancy in women whose illness could be managed without mood-stabilizing medication for prolonged periods.…”

Section: Pregnancy and Recurrence Risk In Bdmentioning

confidence: 99%

Managing Bipolar Disorder during Pregnancy: Weighing the Risks and Benefits

et al. 2002

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Background: Challenges for the clinical management of bipolar disorder (BD) during pregnancy are multiple and complex and include competing risks to mother and offspring. Method: We reviewed recent research findings on the course of BD during pregnancy and postpartum, as well as reproductive safety data on the major mood stabilizers. Results: Pregnancy, and especially the postpartum period, are associated with a high risk for recurrence of BD. This risk appears to be limited by mood-stabilizing treatments and markedly increased by the abrupt discontinuation of such treatments. However, drugs used to treat or protect against recurrences of BD vary markedly in teratogenic potential: there are low risks with typical neuroleptics, moderate risks with lithium, higher risks with older anticonvulsants such as valproic acid and carbamazepine, and virtually unknown risks with other newer-generation anticonvulsants and atypical antipsychotics (ATPs). Conclusions: Clinical management of BD through pregnancy and postpartum calls for balanced assessments of maternal and fetal risks and benefits. Contexte: Les problèmes liés au traitement clinique du trouble bipolaire (TB) durant la grossesse sont profonds et peuvent entraîner des risques concurrents pour la mère et l'enfant. Méthode: Nous avons examiné les résultats récents de la recherche sur le cours du TB durant la grossesse et le post-partum, de même que les données d'innocuité reproductrice des principaux régulateurs de l'humeur. Résultats: La grossesse et surtout la période du post-partum comportent des risques élevés de récurrence du TB. Les risques semblent être limités par les traitements aux régulateurs de l'humeur et notablement accrus par la cessation abrupte de ces traitements. Toutefois, les médicaments utilisés pour traiter ou prévenir les récurrences du TB varient beaucoup en ce qui concerne les risques tératogènes: les risques sont faibles pour les neuroleptiques typiques, modérés pour le lithium, élevés pour les anciens anticonvulsivants comme l'acide valproïque et la carbamazépine, et presque inconnus pour les autres anticonvulsivants de la nouvelle génération et les antipsychotiques atypiques (APA). Conclusions: Le traitement clinique des femmes souffrant du TB durant la grossesse et le post-partum demande des évaluations équilibrées des risques et des avantages pour la mère et le foetus.

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Protective effect of pregnancy in women with lithium-responsive bipolar disorder

Cited by 116 publications

References 30 publications

Risk Factors Associated with Childbearing-Related Episodes in Women with Bipolar Disorder

Risk Factors Associated with Childbearing-Related Episodes in Women with Bipolar Disorder

Sixty Years of Lithium Responders

Managing Bipolar Disorder during Pregnancy: Weighing the Risks and Benefits

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