Pregnancy bipolar disorders during

Yonkers KA, Wisner KL, Stowe Z, et al. Management of bipolar disorder during pregnancy and the postpartum period. Am J Psychiatry 2004 161 608-620. 

The cardiovascular teratogenicity of lithium has been summarized in a review of managing bipolar disorder during pregnancy and postpartum (473). While the risk of Ebstein s anomaly is increased, likely 10-20 times more than in the general population, the absolute risk (0.05-0.10%) is small. Fetal ultrasonography was advised at 18-20 weeks of gestation in cases of first trimester lithium exposure (488). 

Davis LL, Shannon S, Drake RG, Petty F. The treatment of bipolar disorder during pregnancy. In Yonkers KA, Little BB, editors. Management of Psychiatric Disorders in Pregnancy. London Arnold, 2001 122-33. 

Viguera AC, Cohen LS, Baldessarini RJ, Nonacs R. Managing bipolar disorder during pregnancy weighing the risks and benefits. Can J Psychiatry 2002 47(5) 426-36. 

Viguera AC, Cohen LS. The course and management of bipolar disorder during pregnancy. Psychopharmacol Bull 1998 34(3) 339 16. 

Retamal P, Cantillano V. Tratamiento de la enfermedad bipolar durante el embarazo y puerperio. [Treatment of bipolar disorder during pregnancy and puerperium period. A case report.] Rev Medical Chil 2001 129(5) 556-60. 

Lack of convincing efficacy for treatment of bipolar disorder suggests risk/benefit ratio is in favor of discontinuing topiramate in bipolar patients during pregnancy... 

In considering whether to maintain patients on lithium during pregnancy, the clinician must take into account the risks of an exacerbation of bipolar disorder to both mother and fetus. Although it would be ideal to avoid lithium therapy, at least during the first trimester, when critical organogenesis is occurring, this may not be possible. 

A 36-year-old woman with bipolar disorder who had taken lithium for 17 years continued to take it and other medications during pregnancy (493). At 35 weeks she developed signs of lithium toxicity, with nausea, diarrhea, and a concentration of 1.25 mmol/1. She delivered a lethargic infant with poor muscle tone, who showed signs of respiratory distress and hypopnea. 

Atypical antipsychotics may be preferable to lithium or anticonvulsants such as carbamazepine if treatment of bipolar disorder is required during pregnancy... 

Lack of convincing efficacy for freafmenf of bipolar disorder or chronic neuropafhic pain suggesfs risk/benefif rafio is in favor of disconfinuing levefiracefam during pregnancy for fhese indicafions... 

Bipolar disorder has a lifetime prevalence of approximately 1%. During pregnancy, untreated bipolar disorder may result in hospitalization, suicidal ideation, violence, loss of employment, malnutrition, and an increased risk of postpartum psychosis. It does not appear that pregnancy provides protection for the risk of recurrence of symptoms. Women who discontinue the use of mood stabilizing drugs abruptly before conception or who have had four or more episodes of recurrence of symptoms have a substantial risk for recurrence during pregnancy. Risk for recurrence in the first 3 to 6 months postpartum has been estimated at 20% up to 80%. Postpartum psychosis may occur in 10% to 20% of women with bipolar disorder. 

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