Risks of adverse pregnancy and birth outcomes in women treated or not treated with mood stabilisers for bipolar disorder: population based cohort study

Abstract

Objective To investigate the risks of adverse pregnancy and birth outcomes for treated and untreated bipolar disorder during pregnancy.Design Population based cohort study using data from national health registers. Setting Sweden.Participants 332 137 women with a last menstrual period anytime after 1 July 2005 and giving birth anytime before the end of 31 December 2009. Women with a record of at least two bipolar diagnoses were identified and grouped as treated (n=320)-those who had filled a prescription for mood stabilisers (lithium, antipsychotics, or anticonvulsants) during pregnancy-or untreated (n=554). Both groups were compared with all other women giving birth (n=331 263).Main outcome measures Preterm birth, mode of labour initiation, gestational diabetes, infants born small or large for gestational age, neonatal morbidity, and congenital malformations. ResultsOf the untreated women, 30.9% (n=171) were induced or had a planned caesarean delivery compared with 20.7% (n=68 533) without bipolar disorder (odds ratio 1.57, 95% confidence interval 1.30 to 1.90).The corresponding values for the treated women were 37.5% (n=120) (2.12, 1.68 to 2.67). The risks of preterm birth in both treated and untreated women were increased by 50%. Of the untreated women, 3.9% (n=542) had a microcephalic infant compared with 2.3% (324 844) of the women without bipolar disorder (1.68, 1.07 to 2.62). The corresponding values for the treated women were 3.3% (n=311) (1.26, 0.67 to 2.37). Similar trends were observed for risks of infants being small for gestational age infants for weight and length. Among infants of untreated women, 4.3% (n=24) had neonatal hypoglycaemia compared with 2.5% (n=8302) among infants of women without bipolar disorder (1.51, 1.04 to 2.43), and 3.4% (n=11) of the treated women (1.18, 0.64 to 2.16). The analyses of variation in outcomes did not support any significant differences between treated and untreated women.Conclusions Bipolar disorder in women during pregnancy, whether treated or not, was associated with increased risks of adverse pregnancy outcomes. IntroductionBipolar disorder is a chronic and episodic severe mental disorder, often requiring continuous mood stabilising treatment to prevent relapses and to lower the risk of suicide.1 2 Lithium, certain anticonvulsants, and antipsychotics are recommended as mood stabilisers in bipolar disorder.2 Knowledge about the consequences of treatment with mood stabilisers during pregnancy is, however, limited. Antipsychotics during pregnancy have been associated with congenital malformations, preterm birth, and abnormal fetal growth. [4][5][6][7] In a recent study, however, we could not confirm an association between antipsychotics during pregnancy and abnormal fetal growth, except for an increased risk of macrocephaly after use of clozapine or olanzapine.8 Furthermore, antipsychotics, regardless of type, were associated with increased risks of gestational diabetes.8 Lithium, valproate, and carbamazepine have been associated with congenital malformat...

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

“…The issues most frequently raised are fear of adverse effects of medications on the fetus, fear of illness recurrence, and genetic transmission to offspring 507. Other important topics to review include the effect of BD on risk for gestational hypertension, antepartum haemorrhage, induction of labour, caesarean section, instrumental delivery, preterm delivery, and neonatal size 508, 509. Discussion of modifiable risk factors is critical in pre‐conception management of BD.…”

“…Discussion of modifiable risk factors is critical in pre‐conception management of BD. For instance, pregnant women with BD are more often overweight, more often smoke tobacco during pregnancy, have poorer diet quality, and present more often with a history of drug and alcohol misuse in pregnancy 509. Modification of these risk factors may have a significant positive impact on outcomes for both the mother and child.…”

Risks and benefits of psychotropic medication in pregnancy: cohort studies based on UK electronic primary care health records

“…71 Pilo et al 71 demonstrated a higher rate of children born with respiratory distress (odds ratio 2.06, 95% CI 1.62 to 2.63). Another Swedish study 112 also based on national health registries demonstrated that women with bipolar disorder treated with psychotropic medication (anticonvulsant mood stabilisers, lithium or antipsychotics) were more likely to experience caesarean section and preterm delivery. Discontinuation and factors associated with continuation of psychotropic medication in pregnancy l The overall patterns of discontinuation of psychotropic medication were remarkably similar between classes of psychotropic medication.…”

Fertility Rate Trends Among Adolescent Girls With Major Mental Illness: A Population-Based Study

“…[19][20][21] Furthermore, the negative impact of maternal mental illness on child development and child psychopathology is substantial. [22][23][24] Given that adolescents are at high risk of adverse pregnancy outcomes, children of adolescent mothers with mental illness may be "doubly" vulnerable due to the independent risks associated with being the child of both an adolescent and a woman with a major mental illness.…”