January 2004 · Vol. 16, No. 1What Ob/Gyns need to know about drug therapy in bipolar gravidas
Careful attention to dosing, drug combinations, and the risks of key psychotropic agents can help prevent fetal malformations and reduce the risk of relapse.
LORI
ALTSHULER,
MD;
KIMBERLY
YONKERS,
MD;
MISTY
RICHARDSDr. Altshuler is professor, department of psychiatry and biobehavioral sciences, University of California, Los Angeles. Dr. Yonkers is associate professor, department of psychiatry, Yale University, New Haven, Conn. Ms. Richards is Undergraduate Scholarship Program Scholar, National Institute of Mental Health, Bethesda, Md.
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KEY POINTS
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All psychotropic medications cross the placenta. If psychotropic medication is used, prescribe carefully during the first trimester, giving the minimum number of drugs and the lowest dosages needed to restore or maintain well-being.
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No psychotropic agents are FDA-approved for use in pregnancy.
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Teratogenicity notwithstanding, psychotropic intervention is the most effective treatment for women with bipolar disorder.
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We recommend that women who continue to take valproate or carbamazepine during pregnancy receive folate, 3 to 4 mg/d, as a precaution.
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Managing gravidas with bipolar disorder requires obstetricians to balance the potential for neonatal malformations against the high risk of relapse when patients discontinue medications.1 This article offers an evidence-based approach that includes:
When a patient is at risk for severe psychiatric problems before, during, and after pregnancy, a collaborative effort between the obstetrician and psychiatrist may be best for both the patient and her child.
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