Deciding whether or not to continue psychiatric medication during pregnancy is often a difficult choice for women. Regardless of what she chooses, a pregnant woman may face risks to herself and her baby.
In most healthy pregnancies, women are given strict guidelines about medications that are safe for a developing fetus. Many commonly used treatments like over the counter pain medicines or cold medication are not allowed during pregnancy and women must bear mild sickness or pain without pharmaceutical help.
For the thousands of women who experience a significant psychiatric disorder such as bipolar disorder, the decision is even more difficult.
Mood stabilizers used to treat bipolar disorder carry the risk of causing birth defects. Unfortunately, research also shows discontinuing the use of effective mood stabilizing medication leads to relapse in many women, which can also pose dangers to both mother and child.
One study found pregnant women with bipolar disorder who stopped their medication were much more likely to relapse than those who continued medications throughout pregnancy.
More than 85 percent of women who stopped medication experienced a recurrence of at least one mood episode versus 37 percent of those who continued on medications. Women who stopped their medication also reported being ill for 40 percent of the time compared with only eight percent among the women who maintained their bipolar medication.
Women who stopped their medication abruptly had a 50 percent risk of recurrence within just two weeks. Those who discontinued more gradually reached the same risk in 22 weeks.
Mood stabilizing medications carry risks of causing birth defects such as neural tube and cardiovascular abnormalities which can be dangerous to a baby.
Unfortunately, untreated bipolar disorder can also be dangerous and can lead to poor prenatal care, inadequate nutrition, substance use, disrupted mother/infant bonding and family stress. Women who fall into depression are also at a higher risk for suicide. Research also suggests children of depressed parents are more likely to experience behavioural and emotional difficulties.
In the case of neural tube defects, the greatest risk is very early in pregnancy – often before a woman even knows she is pregnant. In these cases, if a woman learns she is pregnant and then rapidly discontinues her medication, the risk to her health may be more than the protective effects of stopping medication.
When it comes to the decision of whether or not to continue on bipolar disorder medication while pregnant, there is no easy answer. It is best to carefully consider all risks and options with your doctor before getting pregnant and come up with a strategy that will work best for you. Every situation is different.
Effective communication and planning is very important and is a critical step toward achieving a healthy pregnancy and transition to parenthood.