Bipolar Disorder in Pregnant Women Not Improved by Psychotropic Medications

Pregnant women with bipolar disorder (BD) receiving psychotropic medication did not experience improvement in either functional impairment or symptom burden, according to a study published in Bipolar Disorders Journal.¹

Dr Kara E. Driscoll from the University of Pittsburgh in Pennsylvania, and colleagues conducted a naturalistic study of 152 pregnant women with BD at or prior to 20 weeks’ gestation. Maternal assessments were completed at 20, 30, and 36 weeks’ gestation, and 2, 12, 26, and 52 weeks postpartum using the Structured Interview Guide for the Hamilton Depression Rating Scale-Atypical Depression Supplement (SIGH-ADS), which contains the 17-item Hamilton Rating Scale for Depression (HAM-D-17), and Mania Rating Scale (MRS).

Outcome measurements were compared in 3 groups of women: women who received no psychotropic medication (42.1% of participants), women who stopped taking psychotropic medication after their first trimester (15.1%), and women who took psychotropic medication throughout their pregnancy (42.8%).

At all 3 assessments, mean SIGH-ADS scores (16.5-19.6) indicated mild to moderate severity while mean scores for HAM-D-17 (10.4-12.8) were similar in all 3 groups of women with BD.

Depression symptom levels and manic scores were statistically insignificant in the 3 groups and remained relatively constant throughout the study period.

The majority of participants scored a 0 on the MRS, and the number of participants who had a non-zero score did not differ significantly in the 3 groups.

“The treatment of pregnant and postpartum women with BD is a clinical challenge,” wrote Dr Driscoll. “Improving psychiatric care for childbearing women with BD deserves further urgent clinical and research attention to improve psychiatric treatment delivery and to optimize perinatal mental health.”

Summary

• Pregnant women with BD who received perinatal and postpartum psychotropic medication did not have less functional impairment and symptom burden than women who did not receive medication
• Depression and mania scores remained relatively constant throughout pregnancy and during the postpartum period

Study Limitations

• The results of the study may not be applicable to women who have more severe disorders as all of the participants in this study were able to provide informed consent, participate in follow-up assessments, and meet eligibility criteria.
• Approximately a third of participants were given psychotropic medications without an established efficacy for bipolar disorder.
• The postpartum follow-up rate was 70%, which could mean that “worsening of illness and inability to be reached for follow-up accounted for postpartum attrition.”

Reference

Driscoll KE, Sit DKY, Moses-Kolko EL, et al. Mood symptoms in pregnant and postpartum women with bipolar disorder: a naturalistic study. Bipolar Disord. 2017;19(4):295-304. doi:10.1111/bdi.12500.