Screening for bipolar disorder during pregnancy

Bipolar disorder is a high-risk condition during pregnancy. In women receiving prenatal care, this study addresses the proportion screening positive for bipolar disorder with or without also screening positive for depression. This is a pilot study using chart abstraction of Edinburgh Postnatal Depression Scale (EPDS) and Mood Disorder Questionnaire (MDQ) scores from patients’ initial prenatal visits. Among 342 participants, 289 (87.1 %) completed the EPDS, 277 (81.0 %) completed the MDQ, and 274 (80.1 %) completed both. Among EPDS screens, 49 (16.4 %) were positive. Among MDQ screens, 14 (5.1 %) were positive. Nine (21.4 %) of the 42 participants with a positive EPDS also had a positive MDQ. Of the 14 patients with a positive MDQ, five (35.7 %) had a negative EPDS. The prevalence of positive screens for bipolar disorder in an obstetric population is similar to gestational diabetes and hypertension, which are screened for routinely. Without screening for bipolar disorder, there is a high risk of misclassifying bipolar depression as unipolar depression. If only women with current depressive symptoms are screened for bipolar disorder, approximately one third of bipolar disorder cases would be missed. If replicated, these findings support simultaneous screening for both depression and bipolar disorder during pregnancy.