Bipolar Medication & Pregnancy: What Are the Risks?

When working with pregnant women affected by bipolar disorder, doctors inevitably face some stark choices. On one hand, suspension of the use of bipolar medications could lead to serious harm from a relapse back into active symptoms. On the other hand, many of the medications proven effective in managing bipolar symptoms can lead to serious problems for both mother and child. Let’s look at some of the most significant risks posed by these medications when used during pregnancy.

Pregnancy and Bipolar Disorder

Pregnancy and the months following childbirth can be extremely challenging for any woman. Generally speaking, the potential obstacles increase for women affected by a serious mental illness. Unfortunately, the risks rise even higher for women affected by some form of bipolar disorder. In fact, current evidence suggests that pregnant women and new mothers with a bipolar illness have greater odds of facing serious mental health-related obstacles than their counterparts affected by other mental illnesses. They also have greater odds of experiencing problems when caring for their newborns.

Common Bipolar Medications

A number of medications have received approval from the U.S. Food and Drug Administration as bipolar disorder treatments. The list of approved options includes:

• Lithium (e.g., Lithane or Lithobid)
• Atypical antipsychotics (e.g., risperidone/Risperdal and aripiprazole/Abilify), and
• Anti-seizure medications such as valproic acid/valproate (e.g., Depakote) and carbamazepine (e.g., Tegretol)

Doctors also sometimes prescribe medications not specifically approved to treat bipolar symptoms.

Risks for Pregnant Women

Unfortunately, many widely used bipolar medications pose a potential threat to the health of pregnant women and/or their developing fetuses. The specific risks vary from medication to medication. For example, the use of lithium in the later months of pregnancy can lead to serious complications in newborns that include:

• Heart problems
• An underactive thyroid gland
• Liver problems
• Breathing problems, and
• A kidney disorder called diabetes insipidus (which, despite its name, is not related to type 1 or type 2 diabetes)

Carbamazepine is specifically known for its ability to produce birth defects, especially when used in combination with valproate. Other problems associated with use of the medication by pregnant women include:

• Underweight newborns, and
• A vitamin K deficiency that can interfere with normal fetal development in several ways

Valproate can also cause birth defects, even when not used in combination with carbamazepine. Some of these defects can lead to lifelong intellectual disabilities. Use of the medication during pregnancy can also lead to additional problems in newborns that include:

• Liver damage
• Low blood sugar, and
• Valproate withdrawal syndrome

Researchers know less about the potential harmful effects of antipsychotic medications on pregnant women and developing fetuses. However, one study indicates that a specific antipsychotic called olanzapine (Zyprexa) can potentially trigger pregnancy-related problems such as:

• Resistance to the normal effects of insulin and/or full-blown gestational diabetes
• Weight increases, and
• A serious, multi-symptom pregnancy complication known as preeclampsia

If you have bipolar disorder, make sure to consult your doctor in detail about all pregnancy-related risks associated with your medications. Resources Brown University: Bipolar Disorder Risks for Perinatal Women https://news.brown.edu/articles/2014/02/bipolar Drug, Healthcare and Patient Safety: Treatment of Bipolar Disorders During Pregnancy – Maternal and Fetal Safety and Challenges https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4284049/ Medscape: The Management of Bipolar Disorder During Pregnancy https://www.medscape.com/viewarticle/565128_4