Should pregnant women with bipolar disorder continue mood stabiliser treatment during pregnancy?

The common practice of abruptly discontinuing mood stabiliser therapy among pregnant women with bipolar disorder has been shown to severely increase maternal morbidity, underscoring the need to carefully weigh up the pros and cons of continuing prophylactic treatment. Women with bipolar disorder encounter several dilemmas with regards to the management of their illness during pregnancy. These include a lack of knowledge regarding the effects of pregnancy on the course of the illness, the reproductive risks associated with many mood stabilisers, as well as the risks associated with ceasing medication during pregnancy. Currently, it is common practice of ceasing mood stabiliser treatment during pregnancy. Viguera et al. sought to estimate the risk of recurrence of mood episodes among women with a history of bipolar disorder. They conducted a prospective observational clinical cohort study involving 89 pregnant women (mean age 32.7 years) with DSM-IV bipolar disorder. Subjects were followed through the end of pregnancy and for 12 months postpartum whether they continued with their mood stabiliser medication or not. The results revealed that during pregnancy, 71% of subjects experienced at least one episode of illness with a recurrence risk 2.3 times greater following discontinuation of mood stabiliser medication. Subjects who continued their mood stabiliser medication during pregnancy spent approximately 10% of their pregnancy in an illness episode compared with over 40% for those who discontinued their medication. Furthermore, the median recurrence latency was found to be 11 times shorter for subjects who discontinued their medication abruptly compared with those who discontinued gradually. The authors stated that the results of their study added weight to the argument that women with bipolar disorder who discontinue their mood stabiliser medication during pregnancy carry a high risk of illness recurrence during pregnancy. They concluded: “the present findings challenge the evidently common practice of abruptly stopping maintenance treatment for psychiatric disorders during pregnancy.” Furthermore, they pointed out that given the high risk of maternal morbidity associated with discontinuation of mood stabilising treatment and the uncertainty surrounding the impact of foetal development, greater consideration should be given to the risks and benefits associated with managing pregnancy women with bipolar disorder. Reference...