Bipolar disorder and psychotropic medication: Impact on pregnancy and neonatal outcomes

Abstract

Objective: The hypotheses were: (1) pregnant women with bipolar disorder (BD) have less favorable pregnancy outcomes than unaffected women, and (2) psychotropic treated women with BD have better outcomes than un-medicated women.

Method: This prospective study included 174 mother-infant dyads. Women had BD without psychotropic exposure (BD-NP, n = 38), BD with psychotropic treatment (BD-P, n = 49), or neither psychotropic exposure nor major mood disorder (Comp, n = 87). Maternal characteristics were completed at 20 weeks gestation and evaluated for associations with delivery and birth outcomes. We performed multiple regressions on infant outcomes with adjustment for maternal age, race, employment status, use of illicit drugs and pre-pregnancy BMI.

Results: The BP-P, BP-NP and Comp groups varied significantly on sociodemographic characteristics. Women with BD were more likely to be less educated, unemployed, single, and use tobacco and illicit drugs than women in the Comp group. Compared to women with BD-NP, women with BD-P were more likely to be older and educated. Approximately 10% of all infants were delivered preterm. No significant differences in outcome occurred for APGAR scores < 8, NICU admissions, sex or infant length. Infants of mothers with BD-NP had significantly smaller head circumferences (HC) than the other groups, adjustment for confounding variables mitigated this association.

Conclusions: The overall pregnancy outcomes for women with BD were similar to those in the Comp group. The reduced HC in women with untreated BD appears due to factors related to disadvantaged sociodemographic status, a higher proportion of female births, and/or a protective effect of medication in the BD-P group.

Trial registration: ClinicalTrials.gov NCT00279370 NCT00585702.

Keywords: Newborn; Perinatal psychiatry; Postpartum; Pregnancy; Psychopharmacology.

Conflict of interest statement

Conflicts of interest

Dr. Sit received donations of study light boxes from Uplift Technologies for a study of light therapy for bipolar depression. Drs. Wisner, Bogen, Clark and Ciolino and Ms. Pinheiro, O’ Shea and Yang have no conflicts to disclose.

Copyright © 2018. Published by Elsevier B.V.

Figures

Fig. 1.

Study subject flow ADUP = Antidepressant Use during Pregnancy AMUP = AntimanicUse During Pregnancy BD-P = Bipolar Disorder with Psychotropic Treatment BD-NP = Bipolar Disorder without Psychotropic Treatment Comp = UnmedicatedWomen without Bipolar Disorder.