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Cited by 394Maternal Mental Health During Pregnancy and PostpartumBipolar Disorder and TreatmentPregnancy and Medication Impact

Management of bipolar disorder during pregnancy and the postpartum period

Yonkers, Kimberly A., Wisner, Katherine L., Stowe, Zachary, Leibenluft, Ellen, Cohen, Lee, Miller, Laura, Manber, Rachel, Viguera, Adele +2 more·2004·American Journal of Psychiatry
DOI 10.1176/appi.ajp.161.4.608
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Abstract

OBJECTIVE: Bipolar disorder affects 0.5%-1.5% of individuals in the United States. The typical age at onset is late adolescence or early adulthood, placing women at risk for episodes throughout their reproductive years. General guidelines for the treatment of bipolar disorder are available from the American Psychiatric Association, but additional issues arise when these guidelines are applied in the treatment of peripartum women. The authors summarize knowledge regarding the management of bipolar disorder during pregnancy and the postpartum period, with a focus on managing mania, hypomania, and the psychotic components of the illness. METHOD: An expert panel reviewed articles that address the management of bipolar disorder and the consequences of the use of mood stabilizers during pregnancy, and a consensus document was generated. RESULTS: The treatment of bipolar disorder in pregnant women involves significant challenges. Some mood stabilizers, e.g., sodium valproate and carbamazepine, are human teratogens. On the other hand, the teratogenicity associated with lithium may have been overestimated in the past. CONCLUSIONS: Since treatment can be managed most effectively if pregnancy is planned, clinicians should discuss the issue of pregnancy and its management with every bipolar disorder patient who has childbearing potential, regardless of future reproductive plans. Additional research should address the risks of disturbed sleep to pregnant and postpartum women with bipolar disorder, as well as structural and behavioral consequences to offspring when mood stabilizers are used during pregnancy. Longitudinal and cohort studies can promote these efforts. Given the rate of bipolar disorder in the general population, research efforts will need to be broad based and include multiple collaborating centers.

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Crossref · 10.1176/appi.ajp.161.4.608

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  • Women who develop postpartum psychosis usually receive a diagnosis consistent with bipolar depression, mania, or mixed state with psychotic features.

    “Mothers who develop postpartum psychosis usually have a diagnosis consistent with bipolar depression, mania, or mixed state, with psychotic features [27].”

    From Perinatal mental illness: Definition, description and aetiology (2014) · cites this paper as [27]

  • Sleep deprivation and disrupted circadian rhythms during late pregnancy, labour, and frequent newborn feeding promote mood destabilization.

    “Sleep deprivation and interference with circadian rhythms during late pregnancy, labour, and frequent newborn feeding promote mood destabilization [27].”

    From Perinatal mental illness: Definition, description and aetiology (2014) · cites this paper as [27]

  • To the extent that benzodiazepines are associated with teratogenic effects, many experts consider the absolute increase to be small.

    “To the extent that benzodiazepines are associated with teratogenic effects, many experts consider the absolute increase to be small (Dolovich et al., 1998; Yonkers et al., 2004).”

    From A Review of Alprazolam Use, Misuse, and Withdrawal (2018) · cites this paper as Yonkers et al., 2004

  • Current evidence seems to suggest that Fallot's tetralogy is not considerably elevated with lithium compared to the rate in the general population.

    “Current evidence seems to suggest that Fallot's tetralogy is not considerably elevated with lithium compared to the rate in the general population (560).”

    From Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care (2011) · cites this paper as [560]

  • A number of mood stabilizers have been associated with fetal malformations, including carbamazepine and valproate.

    “Furthermore, a number of mood stabilizers have been associated with fetal malformations, including carbamazepine and valproate (560,561).”

    From Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care (2011) · cites this paper as [560]

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Authors
Yonkers, K. A., Wisner, K. L., Stowe, Z., Leibenluft, E., Cohen, L., Miller, L., Manber, R., Viguera, A., Suppes, T., & Altshuler, L.
Affiliations
Yale University (US)
ORCID
Venue
American Journal of Psychiatry
Publisher
American Psychiatric Association Publishing
Published
2004-04-01
Volume
161
Issue
4
Pages
608-620
ISSN
  • 0002-953X (ISSN-L)
  • 1535-7228
DOI
10.1176/appi.ajp.161.4.608
OpenAlex
W2124391299
Cited by
394
References
106
Citations by year
2026: 5 · 2025: 7 · 2024: 9 · 2023: 10 · 2022: 10 · 2021: 11 · 2020: 8 · 2019: 11 · 2018: 16 · 2017: 15 · 2016: 23 · 2015: 22 · 2014: 30 · 2013: 22 · 2012: 24
FWCI
23.19
Type
journal article
Language
en
Open access
closed
Locations
  • American Journal of Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
  • Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pregnancy and Medication Impact
Keywords
bipolar disorder, pregnancy, postpartum period, peripartum women, mania, hypomania, psychosis, mood stabilizers, lithium, valproic acid, carbamazepine, teratogenicity, pregnancy planning, sleep disorders, offspring outcomes
MeSH terms
Lamotrigine, Adolescent, Adult, Anticonvulsants, Bipolar Disorder, Carbamazepine, Female, Embryonic and Fetal Development, Fetal Diseases, Humans, Pregnancy, Prenatal Exposure Delayed Effects, Antipsychotic Agents, Triazines, Valproic Acid, Lithium Carbonate, Antimanic Agents, Postpartum Period

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