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Amanda Bowman
ENG 1201
Prof. Furaha Henry-Jones
October 30, 2014

Bipolar Disorder and Pregnancy

Anyone with bipolar disorder or other mental health issues that are taking medications
for it should consider the risks and benefits of taking the medications while pregnant or trying
to become pregnant. They should be as informed as possible on the side effects of the
medications they are taking and the harm that can be caused to a developing fetus. Another
factor that needs to be discussed with the expectant mother is abruptly discontinuing the
medication. Without proper education on these issues, more harm can be done to the fetus
than good and there is also a chance of relapse to the mother.
The problem with the flawed thinking on the topic of bipolar disorder and how it affects
pregnancy is that bipolar disorder affects a lot of women as well as men and the more informed
people are, the better off they are. The more health care workers that know about the disorder

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and the affects the medications have on pregnancy, the better the chances are of having a
healthy baby. This also decreases the mother's chance of relapse of the disorder. A relapse can
harm the baby with the increased stress levels of the mother and the increased morbidity rate
as well.
Bipolar disorder, also called manic depressive disorder, is a severe mental illness that is
characterized by mood swings of depression and mania. The highs and lows of the disorder can
interfere with work, social life and activities of daily living. Bipolar disorder can be treated
usually with a cocktail of medications or a combination medication. Commonly used
medications are mood stabilizers, antidepressants, and antipsychotics. These can all be very
harmful to the development of a fetus. It is estimated that bipolar disorder affects one in 100
people with typical onset in the teenage years (Graham).
The best way to prevent any harm from happening to a child is prenatal planning. When
the medications are prescribed, the patient should be warned of the potential risks that are
involved when becoming pregnant. Not just the harm that can be done in utero to the baby but
also the medication contradictions with oral contraceptives and the importance of other
methods of birth control. A woman with bipolar disorder wanting to become pregnant should
talk with their psychiatrist and their obstetrician at least three months before trying to become
pregnant to discuss the health of the mother and the medications she is taking and the
possibility of PCOS. They should consider optimizing the patients mood at least 3 to 6 months
before conception. Also at this meeting, a discussion should take place to make sure the patient
understands all the risks of possible relapse, the risks and benefits of continuing or

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discontinuing medication during pregnancy, and the patients personal preferences regarding
medication use during pregnancy and breastfeeding (Mytille Vemuri and MD).
A new mother just finding out that she is pregnant may decide to discontinue her
medication, probably thinking it is the best thing to do for the unborn child. This may not be
true, however. Suddenly stopping medication can cause a relapse of the original bipolar
symptoms including: depression, mania, mixed mania, the danger of impulsivity, and an
increased risk of suicidal thoughts (Mytille Vemuri and MD).
Untreated depression that can be part of a relapse can cause attachment issues,
increased alcohol or tobacco use, poor prenatal care and poor nutrition (Joseph Goldberg).
There are generally three factors when concerning pregnancy and these specific
medications. They are structural tetratogenesis (birth defects), behavioral tetratogenesis
(behavioral problems) and prenatal syndromes (unusual syndromes directly after birth)
(Williams MD).
Antidepressants are commonly taken by people with bipolar disorder. Selective
Serotonin Reuptake Inhibitors (SSRIs) are one of three categories that are going to be
discussed. These medications include Prozac, Zoloft, Paxil, and Celexa. The majority of these
medications show no signs of abnormalities in the child when taken early in the pregnancy. If
they are taken around the time of delivery, however, there is an increased risk of prenatal
syndromes including crying, restlessness, and tremors (Williams MD).

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Tricyclics are also a type of antidepressant and are known to be the safest thus far for
pregnant women. Examples of these are Tofranil and Pamelor. They show no adverse affects on
the baby (Williams MD).
Monoamine oxidase inhibitors (MAOIs) like Parnate and Nardil commonly react with
other medications and can cause malformations in the first trimester and it is not
recommended that they be taken (Williams MD).
Anti-anxiety medications such as benzodiazepines may increase the risk of cleft pallet in
a child if the medication is taken while the child is developing in utero. It is also associated with
feeding problems and prenatal syndrome (Williams MD).
Mood stabilizers such as lithium are said to cause organ malformation if taken in the
first trimester. Lithium also increases the risk of Ebsteins Anomoly, a heart defect, by ten
percent (Williams MD).
Possible affects on a fetus in the first trimester of pregnancy include the same side
effects of the medication that the mother is subject to. The baby is also subject to
malformations, microcephaly, and preterm delivery due to higher levels of a stress serum called
cortisol. This elevated level is due to the mother discontinuing her medication upon
discovering her pregnancy (Graham). Microcephaly is an abnormally small head possibly
causing mental retardation. Hypoglycemia or the lowering of the blood sugar is also a possible
affect (Britannica).

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Another factor that might affect the developing baby is the psychiatric medications
transferring from the placenta to the blood. This can cause organ deformation in the first
trimester and low birth weight and early delivery of the child (Kushkituah). Neural tube defects,
heart defects, and developmental delay or neurobehavioral problems can also be caused by
bipolar medications (Joseph Goldberg).

Figure 1 Madness Medication and Motherhood

It is very important for the health care professional to review the patients history of
recurrent, severe mood episodes. This is essential in assessing the tapering off of medications
before pregnancy and during the first trimester. If possible, monotherapy should be
administered if the medication cannot be tapered off. If the mother is at a high risk of relapse
of depression, mania, and mixed episodes along with the danger of impulsivity, the medication
should be adjusted and decreased to the lowest possible dosage (Mytille Vemuri and MD).
Preventive education is the key to preventing harm to the mother and the child. The
doctors and healthcare workers need to be aware of the risks/benefits of taking the medication
while the patient is pregnant and so does the patient.

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Mental health doesnt get as much attention as other disorders or diseases even though
it affects a great deal of people. Some people might be scared to talk about it because they
dont know what they can do to help. A great social support system is always helpful when
dealing with anything that causes a struggle in life. The more that people know about bipolar
disorder and pregnancy, the safer the mother and baby will be.
Some critics may say that it isnt their problem. It might become their childs issue later
in life if they develop the disorder in their teenage years. They have found evidence that
bipolar disorder has been linked to genetics and also to their upbringing. I think that raising
awareness of the disorder will help those that have to struggle with it every second of every
day will help them fell less alone in the world.
I think some people are scared of the unknown or think that it is just not their problem
so why should they care. So many people are affected by some type of disorder that you
probably run across a few individuals that are affected every time you go to the store.
Some problems with not being correctly informed on whether or not to take medication
are that the fetus can have withdrawal symptoms and cane be at a greater risk for problems.
When discussing bipolar disorder and pregnancy, most people believe that it is not a
good idea for women to become pregnant and continue taking their medication. Newer
research suggests differently.
If people were to talk openly about mental health and pregnancy, then it would raise
awareness and more people with the disorder would know the consequences that possibly wait

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if they become pregnant while on certain medications and what might happen if they abruptly
stop taking them. If people were more open-minded they could help make people with mental
health issues feel more easily accepted. I think this would aid in research and education of
mental health issues over all, not just when pregnancy is concerned.

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Works Cited
Britannica, Encyclopedia. Merriam-Webster. 2014. website. 26 October 2014. <http://www.merriamwebster.com/info/index.htm>.
Casey, Maud. "Madness Medication and Motherhood." 3 April 2006.
<http://media.salon.com/2006/04/madness_medication_and_motherhood.jpg>.
Graham, Judith. "Prescriptive Authority-Ethical Issues." Nurse Prescribing (2013): 3. PDF.
<http://eds.b.ebscohost.com.proxy.ohiolink.edu:9099/eds/detail/detail?vid=7&sid=0b8317c0ca57-45ea-99e159762055b835%40sessionmgr112&hid=114&bdata=JnNpdGU9ZWRzLWxpdmU%3d#db=rzh&AN
=2012032482>.
Hoos, Michelle. http://www.cnn.com. 9 June 2010. Website. 22 October 2014.
<http://www.cnn.com/2010/HEALTH/06/09/pregnancy.bipolar.disorder/>.
Joseph Goldberg, MD. www. webmd.com. 17 September 2004. Website. 22 October 2014.
<http://www.webmd.com/bipolar-disorder/guide/bipolar-disorder-in-pregnancy?page=2>.
Kushkituah, Yudy. "What should be known about bipolar disorder and pregnancy." International Journal
of Childbirth and Education (2014): 8. PDF. 25 October 2014.
<http://eds.b.ebscohost.com.proxy.ohiolink.edu:9099/eds/detail/detail?vid=2&sid=0b8317c0ca57-45ea-99e159762055b835@sessionmgr112&hid=108&bdata=JnNpdGU9ZWRzLWxpdmU=#db=rzh&AN=201
2550773>.
Mytille Vemuri, MD, MBA and Katherine Williams MD. www.currentpsychiatry.com. September 2011.
Website. 22 October 2014.
<http://www.currentpsychiatry.com/index.php?id=22661&tx_ttnews[tt_news]=176260>.
Shelia Ward, CMN and Katherine L. Wisner, MD, MS. "Collaborative Management of Women With
Bipolar Disorder During Pregnancy and Post-partum:Pharmacologic considerations." Journal of
Midwifery and Women's Heath (2007): 3-13. journal.
<http://journals.ohiolink.edu/ejc/article.cgi?issn=15269523&issue=v52i0001&article=3_cmoww
bdpappc>.
Staff, The Mayo Clinic. www.mayoclinic.org. 16 October 2014. Website. 22 October 2014.
<http://www.mayoclinic.org/diseases-conditions/bipolar-disorder/basics/treatment/con20027544>.

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Williams MD, M. T. Epigee Women's Health. 2014. webpage. 2014.
<http://www.epigee.org/mental_health/meds_pregnancy.html>.