Bipolar Disorder and pregnancy involves special challenges. Women who have Bipolar Disorder who wish to become pregnant, or who do become pregnant, must face the possibly harmful effects of bipolar medication on the fetus and the nursing infant.

Any woman with Bipolar Disorder wishing to become pregnant should discuss this desire first with her doctor, as the doctor should be familiar with any risks of her bipolar medication on an unborn child and/or nursing infant. There are available treatment options to all patients who have Bipolar Disorder, and her doctor will be able to discuss the benefits and risks to all available treatment options.

The concern for a woman with Bipolar Disorder and pregnancy is not only medication-related, but that the stress of pregnancy would be a trigger to a bipolar episode. Pregnancy, especially during the postpartum period, has been associated with a higher risk of recurrence of Bipolar Disorder; however, the natural stress of a bipolar episode would not necessarily present any physical risk to the fetus. The question would be whether the medication the pregnant woman would have to take for her Bipolar Disorder would pose any potential harm to the unborn fetus or the nursing infant.

Women with Bipolar Disorder do not have to avoid pregnancy altogether. Counsel for pregnancy can help the woman with the disorder manage her bipolar to minimize her symptoms, avoiding an episode, and avoiding risks to the fetus. Experts have suggested, for example, that it is important to avoid sudden changes in bipolar medication during pregnancy, because these changes could increase risks to the unborn child, and also increase the risk of a bipolar episode before or after the pregnant woman gives birth.

If bipolar medication is needed for a pregnant woman, it is recommended that the least amount of medications and in the smallest dosage be prescribed, especially in the first trimester of pregnancy, to maintain stabilization and well-being to the pregnant woman with Bipolar Disorder. This reduces the risks to the fetus. It is also recommended that high dose folate should be started before becoming pregnant to reduce the risk of malformations.

Research about bipolar medications used in pregnant women showed that lithium and Thorazine (and other first-generation antipsychotics) are preferred mood stabilizers, because they consistently show minimal risks to the fetus. However, some anticonvulsants, such as Depakote and Tegretol, have been proven to possibly contribute to birth defects in the fetus. Research also shows that it is less harmful to the fetus if the pregnant woman with Bipolar Disorder only takes one mood stabilizer than if she takes multiple medications.

For a woman with Bipolar Disorder who wants to become pregnant, or who is already pregnant, information and careful planning are the keys to successful management of both the Bipolar Disorder and the pregnancy.

Lastly, a pregnant woman with Bipolar Disorder should return to her regular dose of bipolar medication as soon as possible after delivery, to avoid triggering a bipolar episode.