
New Research: Bipolar Disorder and Pregnancy
Must clinicians presume that all their female patients of reproductive age are potentially going to become pregnant? And if so, what treatment option should be offered?
BRIEF COMMUNICATION
Nearly all psychotropics are teratogenic to some degree, or must be presumed so in the absence of good evidence to the contrary. The latter caveat applies to all atypical antipsychotics, for example. Valproate is thought to be about
In that context, a study by
The authors’ introduction provides a brief summary of the literature on the risks of lithium in pregnancy. They note that the National Institute for Health and Care Excellence (NICE) 2014 antenatal
Thus, this UK study illustrates a problem: according to the guidelines, women who are planning pregnancy should not be taking lithium; this is to avoid becoming pregnant while taking the medication and then discontinuing it. But in the US, only about
Overstating the case thus makes the point: at some point, the woman herself must be allowed into this discussion. If she is not planning pregnancy, many options are open (perhaps best not valproate, as above). But these data from the UK remind us that planning is not always successful.
At minimum, we can conclude that specific inquiry about a woman’s reproductive plans is warranted when teratogenic medications-which include nearly all our medications-are used. In Oregon, a program is promoting “
Disclosures:
Dr Phelps is Director of the Mood Disorders Program at Samaritan Mental Health in Corvallis, Ore. He is the Bipolar Disorder Section Editor for Psychiatric Times. [
References:
1. Nonacs R. Polycystic Ovarian Syndrome in Women Taking Valproate. MGH Center for Women’s Health.
2. McCrea RL, Nazareth I, Evans SJ, et al. Lithium prescribing during pregnancy: a UK primary care database study. PLoS One. 2015;10:e0121024.
3. National Institute for Health and Care Excellence. Antenatal and postnatal mental health: clinical management and service guidance.
4. Finer LB, Zolna MR. Unintended pregnancy in the United States: incidence and disparities, 2006. Contraception. 2011;84:478-485.
5. One Key Question. Would you like to become pregnant in the next year?
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