The findings of research that examined whether women with bipolar disorder (BD) treated with psychotropic medication have better pregnancy outcomes than unmedicated women published in the Journal of Affective Disorders found that while infants of unmedicated mothers had significantly smaller head circumferences than infants of medicated mothers or mothers without BD, this association was mitigated after adjusting for other variables. It appeared that pregnancy outcomes were more related to sociodemographic and behavioral factors.
The prospective study enrolled 174 mother-infant pairs, of which 38 women had BD without psychotropic exposure, 49 had BD with psychotropic exposure, and 87 had neither BD nor psychotropic exposure. In order to examine whether women with BD have worse maternal outcomes than unaffected women and psychotropic-treated women with BD have better outcomes than unmedicated women, researchers evaluated maternal characteristics at 20 weeks gestation and assessed delivery and birth outcomes.
Using multiple regressions on infant outcomes and after adjusting for maternal age, race, employment status, illicit drug use, and pre-pregnancy body mass index, researchers found that the 3 groups — mothers with BD medicated with psychotropics, mothers with BD not medicated with psychotropics, and a control group with neither BD nor psychotropic exposure — had significantly varied sociodemographic traits. Women with BD tended to be less educated, unemployed, single, and use tobacco and illicit drugs. Women with psychotropic exposure tended to be older and more educated than women with non-psychotropic exposure.
Both maternal and infant outcomes across the sample were consistent with general population data. Psychotropic drug exposure did not significantly increase the risk for adverse pregnancy and birth outcomes in women with BD. Women with psychotropic treatment had infants with a significantly higher mean head circumference (HC) and higher mean birthweight than women with non-psychotropic treatment. Reduced HC in the offspring of women with untreated bipolar disorder appeared to be related to sociodemographic characteristics.
The study was limited by its small sample size and a 34.5% participation loss at follow-up.
Researchers noted that “these findings suggest that 2 factors (more resources with access to mental health care and greater severity of disease) contributed to engaging in pharmacotherapy during pregnancy in women with BD.” They advocate mechanistic investigation of reduced HC in order to develop focused interventions.
Wisner KL, Sit D, O’Shea K, et al. Bipolar disorder and psychotropic medication: impact on pregnancy and neonatal outcomes. J Affect Dis. 2019;243:220-225.