The DOI matches its Crossref record; 106 of the 106 references it cites were found in a registry or an index.
Management of Bipolar Disorder During Pregnancy and the Postpartum Period
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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In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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
In the citing paper
“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]
In the citing paper
“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]
Citations
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“Psychotherapies for the manic pole of bipolar disorder focus primarily on increasing adherence to treatment with medication, improving functioning in social and occupational domains, minimizing sleep deprivation (since sleep deprivation can precipitate mania [93]), and preventing relapse.”
BackgroundThe Teratogenicity of Anticonvulsant Drugs
Holmes, L. B., Harvey, E. A., Coull, B. A., Huntington, K. B., Khoshbin, S., Hayes, A. M., & RYAN, L. M. (2001) · New England Journal of Medicine · doi:10.1056/nejm200104123441504 · Cited by 661
Calabrese, J. R., Suppes, T., Bowden, C. L., Sachs, G. S., Swann, A. C., McElroy, S. L., Kusumakar, V., Ascher, J. A., Earl, N. L., Greene, P. L., et al. (2000) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v61n1106 · Cited by 498
Self-citationViguera, A. C., Nonacs, R., Cohen, L. S., Tondo, L., Murray, A., & Baldessarini, R. J. (2000) · American Journal of Psychiatry · doi:10.1176/appi.ajp.157.2.179 · Cited by 488
Self-citation
Research works printed but not linked: 2
- Delgado-Escueta A, Janz D: Consensus guidelines: preconception counseling, management, and care of pregnant women with epilepsy. Neurology 1992; 42:149–160
- Crawford P, Appleton R, Betts T, Duncan J, Guthrie E, Morrow J (Women With Epilepsy Guidelines Development Group): Best practice guidelines for the management of women with epilepsy. Seizure 1999; 8:201–217 · DOI
Cited by
Sorted by citations
DE HERT, M., CORRELL, C. U., BOBES, J., CETKOVICH‐BAKMAS, M., COHEN, D., ASAI, I., DETRAUX, J., GAUTAM, S., MÖLLER, H., NDETEI, D. M., et al. (2011) · World Psychiatry · doi:10.1002/j.2051-5545.2011.tb00014.x · Cited by 2,488
Yatham, L. N., Kennedy, S. H., Parikh, S. V., Schaffer, A., Bond, D. J., Frey, B. N., Sharma, V., Goldstein, B. I., Rej, S., Beaulieu, S., et al. (2018) · Bipolar Disorders · doi:10.1111/bdi.12609 · Cited by 1,852
Self-citationWisner, K. L., Sit, D. K. Y., McShea, M. C., Rizzo, D. M., Zoretich, R. A., Hughes, C. L., Eng, H. F., Luther, J. F., Wisniewski, S. R., Costantino, M. L., et al. (2013) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2013.87 · Cited by 1,091
Self-citationPerinatal mental illness: Definition, description and aetiology
O'Hara, M. W., & Wisner, K. L. (2014) · Best Practice & Research Clinical Obstetrics & Gynaecology · doi:10.1016/j.bpobgyn.2013.09.002 · Cited by 986
Self-citationViguera, A. C., Whitfield, T., Baldessarini, R. J., Newport, D. J., Stowe, Z., Reminick, A., Zurick, A., & Cohen, L. S. (2007) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2007.06101639 · Cited by 599
Self-citation
Metadata
- 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
- Published
- 2004-04-01
- Volume
- 161
- Issue
- 4
- Pages
- 608-620
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- 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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