Bipolar Affective Disorder
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Onset of bipolar disorder typically occurs during the childbearing years.
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Strong familial pattern – 10% of first-degree relatives also affected.
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Hypomanic episodes may include high-risk sexual activity that can lead to unintended pregnancy.
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Preconception care is critical to: determine the best regimen for patient; provide an opportunity to mobilize social supports; and develop relapse prevention and management strategies.
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During pregnancy, increased risks of untreated illness include: relapse, C-section, low birth weight, and postpartum psychosis.
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Clinical management depends on response to medications, severity of illness, risk of recurrent episodes and history of the illness.
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Risk of medication must be balanced against risks of bipolar relapse.
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Valproate use during early pregnancy is associated with about 10% risk of neural tube defects or other congenital malformations. Women taking valproate should take 4 mg folate daily to reduce this risk.
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Lithium registry data suggest an increase in cardiac and other anomalies, especially Ebstein’s anomaly with lithium use during pregnancy; however, the absolute risk of malformation is very low – about 1/1000 to 1/2000 exposed births.
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There are limited reproductive safety data on atypical antipsychotic drugs.
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Discuss risks and benefits of medication treatment and the risks of bipolar relapse with the patient, including the implications of postpartum relapse for mother and baby.
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