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Pregnant women with bipolar disorder face ‘extra challenges,’ study shows

Pregnancy associated with resurgence of symptoms in women with bipolar disorder

Women with bipolar disorder have more difficulties during and after childbirth than do women with other psychiatric disorders, according to a recent study published in the Journal of Affective Disorders.

In the study, Cynthia Battle, associate professor of psychiatry and human behavior, and her co-authors, found that women with bipolar disorder more often experience greater resurgence of symptoms and face more challenges as mothers than women being treated for other psychiatric disorders.

Battle has been studying perinatal depression for years and began this particular study because when she was looking at the literature and clinical cases, it became clear to her that women with bipolar disorder have the highest needs of the perinatal population.

“This is a population that empirically has not been studied as much,” Battle said. She and fellow researchers Margaret Howard, professor of psychiatry and human behavior, and Lauren Weinstock, assistant professor of psychiatry and human behavior, looked at the medical records of 334 patients at the Women and Infants Hospital in Providence to find potential candidates for the study.

According to Battle, 10 percent of these 334 cases were women diagnosed with bipolar disorder.

One strength of the study includes the large sample size, which allowed for “statistically significant differences to be noted,”  Mytilee Vemuri, clinical assistant professor of psychiatry and behavioral science at Stanford University, wrote in an email to The Herald.

The reason many women with bipolar disorder struggle during the pregnancy period is because the disease comes with some “unique challenges” that can “really be a risk factor for a new episode of mania,” Battle said. One such challenge is sleep deprivation. According to Battle, sleep disruption and deprivation is one of the main things that leads to mood swings in women with the disorder. Battle said a priority should be to “regulate and prevent sleep disruption” in these women.

Another complication is that 78 percent of women with bipolar disorder report having trouble breastfeeding their infants compared to about 42 percent of women who do not have the disorder, according to a University press release.

Yet another problem is that a lot of medications prescribed for bipolar disorder are considered unsafe during pregnancy, so women cease taking them, Battle said. To combat this problem, Battle and her fellow researchers are working to identify the factors that make some women stay on their medication during pregnancy and others go off of it. It is a murky area for these women, Battle said. “Women are confused about the best option for treatment, so they choose no option,” she said.

Battle said that because of the severity of bipolar disorder, doctors need to watch carefully to distinguish between it and depression in perinatal women. This study will “help guide future efforts to develop support services,” Battle said.

This study is significant because it “confirms that substance abuse and suicidality, known to co-occur in bipolar disorder, are active problems in perinatal women with bipolar disorder,” Vemuri wrote. “It also provides new evidence that perinatal patients with bipolar disorder are at risk for obstetrical and breastfeeding complications.”

But “this study was not able to distinguish whether the higher delivery and breastfeeding complications observed were related to the medications used or to the diagnosis of bipolar disorder alone,” she wrote.


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