Pregnancy and bipolar disorder: a systematic review

J Clin Psychiatry. 2012 Nov;73(11):1447-55. doi: 10.4088/JCP.11r07499. Epub 2012 Aug 21.

Abstract

Objective: The postpartum period is generally considered a time of heightened vulnerability to bipolar disorder; however, there is controversy about the effect of pregnancy on the course of bipolar disorder. This article reviews the literature on the relationship between pregnancy and bipolar disorder and suggests areas for future research.

Data sources and study selection: Three electronic databases, MEDLINE (1966-2010), PsycINFO (1840-2010), and EMBASE, were searched on April 30, 2010, using the following keywords: pregnancy, bipolar disorder, manic depressive disorder, suicide, hospitalization, pharmacotherapy, and psychotherapy. The reference lists of articles identified were also searched. All relevant papers published in English were included.

Results: A total of 70 articles were identified and included in the review. Evidence from studies using nonclinical samples, some retrospective studies, and studies on psychiatric hospitalization rates is suggestive of a positive effect of pregnancy on bipolar disorder; however, recent studies conducted at tertiary care facilities have reported high rates of recurrence following discontinuation of mood stabilizers.

Conclusions: Understanding the relationship between pregnancy and bipolar disorder has implications for perinatal treatment and etiologic understanding of the disorder. Research is urgently needed to estimate the prevalence of bipolar disorder during pregnancy, using both clinical and nonclinical samples.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Age of Onset
  • Antidepressive Agents / adverse effects
  • Antidepressive Agents / therapeutic use
  • Antimanic Agents / adverse effects
  • Antimanic Agents / therapeutic use
  • Antipsychotic Agents / adverse effects
  • Antipsychotic Agents / therapeutic use
  • Bipolar Disorder / diagnosis*
  • Bipolar Disorder / epidemiology
  • Bipolar Disorder / therapy
  • Causality
  • Cross-Sectional Studies
  • Depression, Postpartum / diagnosis
  • Depression, Postpartum / epidemiology
  • Female
  • Hospitalization
  • Humans
  • Infant, Newborn
  • Neonatal Abstinence Syndrome / epidemiology
  • Neonatal Abstinence Syndrome / etiology
  • Pregnancy
  • Pregnancy Complications / diagnosis*
  • Pregnancy Complications / epidemiology
  • Pregnancy Complications / therapy
  • Pregnancy Trimesters
  • Psychotherapy
  • Recurrence
  • Substance Withdrawal Syndrome / diagnosis
  • Substance Withdrawal Syndrome / epidemiology
  • Suicide / prevention & control
  • Suicide / statistics & numerical data

Substances

  • Antidepressive Agents
  • Antimanic Agents
  • Antipsychotic Agents