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Pregnancy and bipolar disorder: the risk of recurrence when discontinuing treatment with mood stabilisers: a systematic review

Published online by Cambridge University Press:  17 November 2016

Erik Roj Larsen  and
Kristina Saric
Erik Roj Larsen*
Affiliation:
Department of Affective Disorders Q, Mood Disorders Research Unit, Aarhus University Hospital, Risskov, Denmark
Kristina Saric
Affiliation:
Department of Affective Disorders Q, Mood Disorders Research Unit, Aarhus University Hospital, Risskov, Denmark
*
Erik Roj Larsen, Department of Affective Disorders Q, Mood Disorders Research Unit, Aarhus University Hospital, DK-8240 Risskov, Denmark. Tel: +45 78 47 21 30; Fax: +45 78472129 E-mail: erlars@rm.dk
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Abstract

Objective

Bipolar disorder in pregnancy may be difficult to treat. The dilemma is whether the women should continue medication throughout pregnancy, and maybe accept a minor risk to harm their unborn child, or discontinue medication and increase the risk of recurrence, which can lead to maternal morbidity, thereby endangering themselves and their foetus.

Design and methods

In September 2016, three electronic search databases; PubMed, Scopus and PsycInfo, were used searching for clinical trials concerning this question. Eight clinical trials concerning risk of recurrence after discontinuation of medication in pregnancy were included.

Results

There is no consensus concerning the risk of discontinuation of medication during pregnancy among bipolar women. The evidence from the trials included underscore that there seem to be a group of pregnant women who are stable despite they are not receiving mood stabilisers during pregnancy. Besides, there is a group of more severe and more unstable bipolar disorders that seem to benefit of a more close monitoring, support and prophylactic medication during pregnancy and postpartum period to prevent recurrence.

Conclusion

For the more stable bipolar women we recommend a well planned and more slowly discontinuation of medication before pregnancy. For the unplanned pregnancies it is important to consider the possibility of a more slowly discontinuation. For the more severe conditions of bipolar disorder, it is important to secure a close monitoring of medication. As the risk of postpartum relapse is high, medication may be started soon after delivery.

Keywords

bipolar disordermedicationmood disorderpregnancydiscontinuation
Type
Review Article
Information
Acta Neuropsychiatrica , Volume 29 , Issue 5 , October 2017 , pp. 259 - 266
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Copyright
© Scandinavian College of Neuropsychopharmacology 2016 

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