Reproductive Health and Bipolar Disorder: Medication, Pregnancy & Bipolar

Welcome to the second blog in our series on reproductive health and bipolar disorder, in collaboration with the Women’s Health Research Institute (WHRI). In this series, we will be drawing from our World Bipolar Day “Ask Me Anything’ and WHRI members Dr. Catriona Hippman and Dr. Jehannine Austin to answer your pressing questions about reproductive health and bipolar disorder. To learn more about women’s health research in BC, check out WHRI.org.

Can pregnant people continue to take medications for bipolar disorder? In this blog post, we’ll cover some of your questions about taking medication for bipolar disorder during pregnancy and postpartum.

There is lots of research into how life events can trigger mood episodes for folks with bipolar disorder, whether they are distressing (e.g., losing a job) or joyful (e.g., the birth of a child). While some research suggests that there is less of a chance of experiencing a mood episode during pregnancy, the risk of experiencing a mood episode after giving birth is heightened. As such, it is important to work with your care team to determine whether you should change your medication, or dosage during these periods. Here, we share answers from our AMA’s and information from about bipolar disorder, pregnancy, postpartum, and medication.

Can I continue my bipolar disorder medication while pregnant?

In general, reproductive psychiatrists recommend pregnant people stay on their medication throughout pregnancy. However, you and your team may make some adjustments to your medication regime to minimize potential side effects of the medication throughout pregnancy for both you and your baby.

Here are Dr. Catriona Hippman’s thoughts on taking medication while pregnant: It’s important to recognize that people who take medications to manage chronic illness (whether mental illness or other types of illnesses) may face intense societal pressure in the form of stigma against taking medication during pregnancy. For those of us (myself included) who take medication to manage a mental illness, we also face the stigma of the mental illness as well. Society tells us that “good moms” don’t take medication in pregnancy. That’s really not fair or supported by research evidence. For many of us (myself included), the benefits of taking the medication during pregnancy (and avoiding the risks to baby of untreated mental illness in pregnancy) outweigh the small risks associated with taking the medications in pregnancy. Having said that, I know of people who have wanted to stop taking their medication anyway (only partially related to pregnancy), and have done very well without medication.

It’s a personal choice, but one that is ideally made in collaboration with your care team and broader support system. Much of my work is dedicated to supporting birthing individuals with these difficult decisions, and my research team has been developing an animated video of the decision-making theory I developed during my PhD. We hope it will help people who are facing the decision of whether or not to take antidepressants during pregnancy, but my guess is that the experience of making that decision is very similar to the experience of deciding whether to take mood stabilizers during pregnancy. Stay tuned for the release of that video (shout out to BC Women’s Health Foundation and an anonymous donor for supporting this work!).

Can I continue taking lithium throughout pregnancy? What about in postpartum?

Yes, pregnant people with bipolar disorder can continue to take lithium throughout their pregnancy. However, some adjustments to medication dosage may be advised throughout pregnancy, and into postpartum. This article is one of the most recent reviews of research into lithium use during pregnancy and postpartum.

Dr. Fabiano Gomes summarized what we know about lithium use in pregnancy and postpartum in our 2022 AMA:

Lithium use during pregnancy

Taking lithium while pregnant can effectively prevent mood episodes during pregnancy and into the postpartum period.
Some additional screening during pregnancy is recommended. For example, monitoring lithium blood levels weekly during the third trimester and after delivery.
Lithium use during pregnancy has not been associated with obstetric complications.
A lower dosage of lithium during the first trimester of pregnancy could be considered, however, this decision should be made in collaboration with a care team and weighed against the risk of experiencing a mood episode.
We know that there may be a small increased chance (~0-7%) of heart defects for babies exposed to lithium in the first trimester of pregnancy, so sonographers doing the 20 week ultrasound will take an extra careful look at the baby’s heart. However, research on this has been mixed, with some indicating no increased chance of heart defects. It is also important to recognize that there is always a 2-5% chance of birth defects for any baby – whether or not they are exposed to medication during pregnancy. (1).

Lithium use in postpartum

If lithium is discontinued during pregnancy, it is highly encouraged to restart it immediately after delivery as it can be an effective strategy for preventing mood episodes postpartum.
A high lithium dosage immediately after delivery and during the first month postpartum may be the most effective strategy for preventing a mood episode.
Some additional screening is recommended, including monitoring lithium blood levels twice a week during the first 2 weeks postpartum.
Breastfeeding while taking lithium is safe and possible, but be sure to talk to your healthcare provider about whether this would be a good option for you. Breastfeeding while on lithium may require extra monitoring of your baby’s symptoms by you and your doctor. Be sure to look for symptoms such as restlessness, low muscle tone, or trouble feeding.

What ways, in addition to/besides medication, can I manage my bipolar disorder while pregnant?

There are many ways pregnant people can manage their bipolar disorder, in addition to medication. In the next blog post for this series, we’ll be discussing some tools you can use to manage bipolar disorder while pregnant. Stay tuned for more advice, tips, and tools from WHRI members in our next blog post!