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bipolar disorder pregnancy

Nancy Byatt, Lucille Cox, Tiffany A Moore Simas, Nisha Kini, Kathleen Biebel, Padma Sankaran, Holly A Swartz, Linda Weinreb
To elucidate (1) the challenges associated with under-recognition of bipolar disorder in obstetric settings, (2) barriers pregnant and postpartum women with bipolar disorder face when trying to access psychiatric care, and (3) how obstetric settings can identify such women and connect them with mental health services. Structured, in-depth interviews were conducted with 25 pregnant and postpartum women recruited from obstetric practices who scored ≥ 10 on the Edinburgh Postnatal Depression Scale and met DSM-IV criteria for bipolar disorder I, II, or not otherwise specified using the Mini International Neuropsychiatric Interview...
March 13, 2018: Archives of Women's Mental Health
Qiong Wu, Christina Dalman, Håkan Karlsson, Glyn Lewis, David P J Osborn, Renee Gardner, Joseph F Hayes
Background: Mounting evidence implicates early life and prenatal immune disturbances in the etiology of severe mental illnesses. Asthma is a common illness associated with chronic aberrant immune responses. We aimed to determine if asthma in childhood and parents is associated with bipolar and schizophrenia spectrum disorders. Methods: A cohort study including all children born in Sweden 1973-1995 (N > 2 million) assessing associations between childhood hospitalization for asthma, parental asthma during and pre-pregnancy, and subsequent bipolar and schizophrenia spectrum disorders...
March 9, 2018: Schizophrenia Bulletin
Louise Michele Howard, Elizabeth G Ryan, Kylee Trevillion, Fraser Anderson, Debra Bick, Amanda Bye, Sarah Byford, Sheila O'Connor, Polly Sands, Jill Demilew, Jeannette Milgrom, Andrew Pickles
BACKGROUND: There is limited evidence on the prevalence and identification of antenatal mental disorders. Aims To investigate the prevalence of mental disorders in early pregnancy and the diagnostic accuracy of depression-screening (Whooley) questions compared with the Edinburgh Postnatal Depression Scale (EPDS), against the Structured Clinical Interview DSM-IV-TR. METHOD: Cross-sectional survey of women responding to Whooley questions asked at their first antenatal appointment...
January 2018: British Journal of Psychiatry: the Journal of Mental Science
Laura J Faherty, Meredith Matone, Molly Passarella, Scott Lorch
BACKGROUND: The prevalence of opioid use during pregnancy is increasing. Two downstream effects are neonatal abstinence syndrome (NAS), a postnatal withdrawal syndrome, and long-term prenatal opioid exposure (LTPOE) without documented withdrawal symptoms in the infant. Mental health characteristics of mothers of infants with NAS and LTPOE have not been described. METHODS: Using linked maternal and infant Medicaid claims and birth certificate data, we analyzed 15,571 infants born to Medicaid-insured women 15-24 years old in a mid-Atlantic city from 2007 to 2010...
February 7, 2018: Maternal and Child Health Journal
Thomas E Elliott, Caitlin K Frail, Pamala A Pawloski, Avis J Thomas, Ann M Werner, Rebecca C Rossom
OBJECTIVES: Determine the prevalence of opioid use before, during, and after pregnancy and describe its use based on patient-specific characteristics. Determine secular trend of opioid use 2006-2014. METHODS: Retrospective cohort study. A large Upper Midwest integrated healthcare system and insurer. Females age 10 to 50 years with a delivery diagnosis from July 1, 2006 through June 30, 2014. MAIN OUTCOME MEASURE: Prevalence of opioid use before, during, and after pregnancy; description of opioid use during these time periods...
February 5, 2018: Clinical Journal of Pain
Michael Thomson, Verinder Sharma
Mood disorders including major depressive disorder and bipolar disorder are common during and after pregnancy. Timely identification and appropriate management of mood episodes is essential to maximize maternal well-being and minimize adverse outcomes. Failure to do so results in maternal suffering and impaired child bonding, and has the potential for devastating outcomes including suicide and infanticide. Women are routinely screened for unipolar depression during or after pregnancy but not for bipolar disorder, in spite of the fact that childbirth is associated with a major risk for onset or exacerbation of bipolar disorder...
December 2017: CNS Spectrums
Sonia Hernandez-Diaz, Krista F Huybrechts, Rishi J Desai, Jacqueline M Cohen, Helen Mogun, Page B Pennell, Brian T Bateman, Elisabetta Patorno
OBJECTIVE: To assess the relative risk of oral clefts associated with maternal use of high and low doses of topiramate during the first trimester for epilepsy and nonepilepsy indications. METHODS: This population-based study nested in the US 2000-2010 Medicaid Analytic eXtract included a cohort of 1,360,101 pregnant women with a live-born infant enrolled in Medicaid from 3 months before conception through 1 month after delivery. Oral clefts were defined as the presence of a recorded diagnosis in claims during the first 90 days after birth...
January 23, 2018: Neurology
A Cuomo, A Goracci, A Fagiolini
BACKGROUND: Aripiprazole is used relatively frequently in women with bipolar disorder or schizophrenia in childbearing years, owing to its efficacy and relatively favorable side effect profile. As is the case for other psychotropic medications, for ethical reasons, no prospective randomized placebo controlled trial to assess aripiprazole safety during pregnancy has ever been conducted. However, animal data are available and the amount of exposure and outcome data for human fetuses and infants has recently increased, providing published prospective safety data in relatively large numbers of pregnant women treated with aripiprazole...
March 1, 2018: Journal of Affective Disorders
Rebecca K Graham, Gabriela Tavella, Gordon B Parker
BACKGROUND: Clinicians treating a patient with bipolar disorder who is pregnant or breastfeeding may seek advice from bipolar management guidelines that provide recommendations for perinatal treatment. We examine the consistency of such recommendations across several evidence-based guidelines. METHODS: A literature search in the National Guideline Clearinghouse, the Cochrane Database of Systematic Reviews, PsycInfo and PubMed was undertaken using the search terms "bipolar disorder" and "guidelines," which generated 11 sets of evidence-based guidelines published by professional organizations during the 2005-2015 period...
December 12, 2017: Journal of Affective Disorders
Charmian Møller-Olsen, Susan Hatters Friedman, Chandni Prakash, Abigail North
INTRODUCTION: We aimed to investigate the characteristics of pregnant women who required either mood stabilizer or antipsychotic treatment. These women requiring such treatment are likely to be more mentally unwell and thus carry a higher burden of comorbidities associated with poor pregnancy outcomes. METHODS: This retrospective review investigated the common characteristics of pregnant women who were prescribed with antipsychotics or mood stabilizers under a major city's public maternal mental health service...
December 11, 2017: Asia-Pacific Psychiatry: Official Journal of the Pacific Rim College of Psychiatrists
Neil Patel, Adele C Viguera, Ross J Baldessarini
PURPOSE/BACKGROUND: High risks of neural tube defects and other teratogenic effects are associated with exposure in early pregnancy to some anticonvulsants, including in women with bipolar disorder. METHODS/PROCEDURES: Based on a semistructured review of recent literature, we summarized findings pertaining to this topic. FINDINGS/RESULTS: Valproate and carbamazepine are commonly used empirically (off-label) for putative long-term mood-stabilizing effects...
February 2018: Journal of Clinical Psychopharmacology
L Forsberg, M Adler, I Römer Ek, M Ljungdahl, L Navér, L L Gustafsson, G Berglund, A Chotigasatien, U Hammar, B Böhm, K Wide
AIM: This study evaluated whether maternal mood disorders (MMD), particularly bipolar disorder, and lithium treatment during pregnancy influenced the neonatal health and cognition of children born from 2006 to 2010. METHODS: Our study at Karolinska University Hospital, Stockholm, Sweden, focused on women with and without mood disorders and their children. Information on pharmacotherapy, mental health, delivery and neonatal complications was retrospectively collected from electronic patient records...
November 18, 2017: Acta Paediatrica
Debra A Scrandis
INTRODUCTION: Women with bipolar disorder may benefit from continuation of their medications during pregnancy, but there may be risks to the fetus associated with some of these medications. This article examines the evidence relating to the effect of bipolar disorder and pharmacologic treatments for bipolar disorder on pregnancy outcomes. METHODS: MEDLINE, CINAHL, ProQuest Dissertation & Theses, and the Cochrane Database of Systematic Reviews were searched for English-language studies published between 2000 and 2017, excluding case reports and integrative reviews...
October 30, 2017: Journal of Midwifery & Women's Health
Esra Yazici, Hilal Uslu Yuvaci, Ahmet Bulent Yazici, Arif Serhan Cevrioglu, Atila Erol
BACKGROUND: Pregnancy and postpartum periods are the main reproductive periods during which women experience mood disorders. Affective temperaments are known antecedents of mood disorders and their importance is increasing in time for early diagnosis and determining risky groups. But data about affective temperaments during perinatal period is limited. METHODS: Women during pregnancy and perinatal period and healthy controls who are not in perinatal period are included in the study...
October 26, 2017: Gynecological Endocrinology
Glenda Gatan Magtanong, Andrea R Spence, Nicholas Czuzoj-Shulman, Haim Arie Abenhaim
PURPOSE: Fibromyalgia (FM) is a rheumatologic disorder marked by chronic, widespread pain and associated comorbid conditions. The purpose of our study was to evaluate the effect of FM on maternal and neonatal outcomes. METHODS: Using the Healthcare Cost and Utilization Project Nationwide Inpatient Sample from 1999 to 2013, we conducted a population-based retrospective cohort study consisting of women who delivered during that period. Logistic regression was used to compare maternal and neonatal outcomes among pregnancies in women with and without FM...
September 27, 2017: Journal of Maternal-fetal & Neonatal Medicine
Kate Womersley
This essay was submitted for the Royal College of Psychiatry's perinatal psychiatry medical student essay prize in 2017. The essay considers the choices available to women with bipolar disorder who become pregnant while taking sodium valproate to treat mania or for mood stabilisation. The implications of three options are considered: to stop all treatment, to switch to a different mood stabiliser or to continue on sodium valproate. The implications for the fetus, on the mother's wellbeing and the ethics of patient choice are discussed...
September 2017: Psychiatria Danubina
Sarah Tebeka, Yann Le Strat, Caroline Dubertret
OBJECTIVE: To assess prospectively the association of the number of past pregnancies on the evolution of bipolar disorder (BD). METHODS: Data were drawn from the 2 waves of the National Epidemiologic Study of Alcohol and Related Conditions (NESARC), a representative sample of the US population of 34,653 participants. All women diagnosed with BD were included. The number of children and BD's characteristics, i.e. BD type, age of onset, hospitalization and suicide attempt, and lifetime psychiatrics comorbidity were assessed at wave 1...
January 1, 2018: Journal of Affective Disorders
Awais Aftab, Asim A Shah
This article describes psychiatric emergencies in pregnant women. The perinatal period is a time of psychiatric vulnerability. Up to 1 in 6 pregnant women experience major depressive disorder, and 1 in 4 pregnant women with bipolar disorder experience mood exacerbation. We discuss the management of severe mental illness in pregnancy, risk to mother and child of untreated psychiatric illness in pregnancy, risk of relapse of psychiatric disorders in pregnancy with medication discontinuation, psychopharmacologic considerations of teratogenicity and other fetal adverse effects, acute agitation in the pregnant patient, suicidality in pregnancy, and emergency considerations related to substance use disorders...
September 2017: Psychiatric Clinics of North America
Aubrey Thyen, Puneet Narang, Simrat Sarai, Gulay Tegin, Steven Lippmann
Women often experience worsening mood disorder symptoms during pregnancy. Women with mood disorders have an increased risk for suboptimal prenatal care, inadequate weight gain, and more substance abuse during pregnancy. It is often difficult to balance pharmacotherapy risks to a developing fetus versus not medicinally treating maternal mental health conditions. Electroconvulsive therapy (ECT) is a rapid and effective treatment option that can be an appropriate intervention in some women during pregnancy. This report presents an overview of ECT in pregnancy and the case of a 28-year-old pregnant woman with bipolar mania who responded well to ECT...
July 13, 2017: Primary Care Companion to CNS Disorders
Nancy Byatt, Lucille Cox, Tiffany A Moore Simas, Kathleen Biebel, Padma Sankaran, Holly A Swartz, Linda Weinreb
Bipolar disorder among pregnant women has deleterious effects on birth and child outcomes and is currently under-detected, not addressed effectively, or exacerbated through inappropriate treatment. The goal of this study was to identify perspectives of pregnant and postpartum women with bipolar disorder on barriers and facilitators to psychiatric treatment during pregnancy. In-depth interviews were conducted with pregnant and postpartum women who scored ≥ 10 on the Edinburgh Postnatal Depression Scale and met DSM-IV criteria for bipolar disorder I, II or not otherwise specified using the Mini International Neuropsychiatric Interview version 5...
July 11, 2017: Psychiatric Quarterly
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