Woman, bipolar disorder and the desire to be a mother

Bipolar disorder is a mental disorder typically characterized by alternating manic and depressive episodes separated by periods of mood stability ( WHO 2019) . Although it is a lifelong condition, in most cases the symptoms can be managed with medication and psychological support.

Many women diagnosed with bipolar disorder express a desire to become mothers. However, they often have many doubts and face prejudice from those around them. It is important to have access to information based on available scientific evidence so that each woman can make the decision she deems appropriate.

The following will attempt to answer some questions that arise in daily clinical practice in relation to bipolar disorder and motherhood:

• If I have bipolar disorder, can I be a mother?

Of course, if you feel capable and want to, bipolar disorder doesn't have to be an obstacle. It's advisable to find the best time and plan your pregnancy.

• But can I be a good mother?

Absolutely. Your role as a mother doesn't have to be affected by having bipolar disorder if you receive the right support, treatment, and guidance.

• What if bipolar disorder is not controlled?

The negative effects on infant care can indeed stem from untreated or poorly treated bipolar disorder. Whether the mother is in a manic or depressive phase, or experiencing postpartum psychosis without treatment, the consequences for the baby, for her, and for those around her can be devastating.

• Are the medications used to treat bipolar disorder safe during pregnancy?

Valproic acid should not be used in any woman of childbearing age since it is contraindicated during pregnancy as it can cause malformations in the baby.

The potential negative effects of lithium and antipsychotics are acceptable when compared to the risks of not treating the condition. However, the risks and benefits should always be assessed individually for each woman.

Closer monitoring of the pregnancy and follow-up from obstetrics are recommended.

If a pregnant woman is taking lithium, more frequent blood tests will be required, including monitoring of lithium levels, as well as a fetal echocardiogram in the first and second trimesters. Although lithium has historically been associated with Ebstein's anomaly, a birth defect in the baby's heart, more recent studies suggest that the drug does not have the teratogenic potential that had been previously attributed to it (Gentile, 2011) .

• Can the medication be reduced or discontinued if I decide to become pregnant?

Each case must be individualized, but it is important to ensure clinical stability. Pregnant women diagnosed with bipolar disorder who discontinue treatment have been shown to have a higher risk of relapse than those who continue treatment. In many cases, it is even necessary to increase the dosage of psychotropic medications as the pregnancy progresses.

• Can I breastfeed if I'm taking treatment for bipolar disorder?

Most psychotropic medications are safe for breastfeeding, but breastfeeding is generally not recommended while taking lithium. In carefully selected women diagnosed with bipolar disorder who are taking lithium, continuing to breastfeed may be a suitable option if both mother and baby are closely monitored (Imaz et al 2021) .

• With the arrival of a child, I sleep fewer hours. Will that cause me to become unwell?

Women diagnosed with bipolar disorder who choose to become mothers are at higher risk of relapse in the postpartum period. It should be noted that many women are first diagnosed with bipolar disorder during the postpartum period. Women with bipolar disorder are more likely to experience postpartum psychosis.

Sleep deprivation is a key factor in triggering a decompensation. It is important to have a family and professional support network that facilitates the mother's nighttime rest.

• Can my son or daughter inherit bipolar disorder?

A woman diagnosed with bipolar disorder has a higher risk of having a child with the disorder than a woman without it. However, there is also a high probability that her child will not develop it. It should be noted that if both parents have the disorder, the risk increases.

• If a mother requires hospital admission due to a bipolar disorder episode, is she separated from her baby?

Unfortunately, in Spain there are no acute mother-baby hospitalization units. These specialized psychiatric units provide care for mothers with severe mental illness and their newborns.

So, although there are cases where a decompensation can be treated – if the symptoms are less severe – on an outpatient basis, in others hospital admission to a conventional acute psychiatric unit will be necessary, and there will be a temporary separation of the mother-baby dyad.

In Catalonia there are some specific resources for perinatal mental health care, such as the Community Perinatal Mental Health Network of the Parc Sanitari Sant Joan de Déu, the pioneering mother-baby day hospital in Spain at the Hospital Clínic of Barcelona, or the Perinatal Mental Health Unit of Vall d'Hebron, among others.

If you have been diagnosed with bipolar disorder or have a family history of it and wish to become a mother:

1. Plan your pregnancy; tell your psychiatrist about your desire to become a mother.
2. Consult your midwife to start folic acid treatment and have blood tests done before your pregnancy.
3. Quit harmful substances such as tobacco, alcohol, drugs, and stimulating drinks like coffee or tea.
4. Maintain a good diet and healthy lifestyle habits .
5. Continue follow-up with your psychiatrist; preferably, seek care through a perinatal mental health program.
6. Attend all required obstetric and analytical check-ups .
7. Involve your trusted circle in detecting potential imbalances.
8. Prioritize getting a good night's sleep .