Bipolar Disorder in Pregnancy and Postpartum: Principles of Management

Curr Psychiatry Rep. 2016 Feb;18(2):13. doi: 10.1007/s11920-015-0658-x.


Pregnancy and postpartum represent times of increased vulnerability for women with bipolar disorder, yet this condition remains under-diagnosed and under-treated. As 50 % of pregnancies are unplanned, the risks associated with the illness and the potential risks associated with treatment should be considered when a woman of reproductive age first presents for evaluation. This article reviews the epidemiology of perinatal bipolar disorder, screening recommendations, and treatment with pharmacotherapy and electroconvulsive therapy (ECT). An overview of the data in pregnancy and lactation is presented for lithium, lamotrigine, valproic acid, newer antipsychotics, and ECT. General principles of management include close monitoring in pregnancy and postpartum, careful adjustment of the treatment regimen to attenuate the risk of relapse, and avoidance of valproic acid when possible. Thoughtful consideration of these issues will minimize the risks to the mother and baby.

Keywords: Antipsychotics; Bipolar disorder; Depression; Lactation; Mood stabilizers; Neonatal complications; Neurodevelopmental effects; Perinatal; Postpartum; Pregnancy; Teratogenicity.

Publication types

  • Review

MeSH terms

  • Antipsychotic Agents / therapeutic use*
  • Bipolar Disorder / diagnosis
  • Bipolar Disorder / drug therapy
  • Bipolar Disorder / therapy*
  • Electroconvulsive Therapy*
  • Female
  • Humans
  • Lactation*
  • Lamotrigine
  • Lithium Compounds / therapeutic use
  • Postpartum Period*
  • Pregnancy
  • Pregnancy Complications / diagnosis
  • Pregnancy Complications / drug therapy
  • Pregnancy Complications / therapy*
  • Risk
  • Triazines / therapeutic use
  • Valproic Acid / therapeutic use


  • Antipsychotic Agents
  • Lithium Compounds
  • Triazines
  • Valproic Acid
  • Lamotrigine