Bipolar Disorder and Pregnancy and Postpartum

Mood Stabilizers in Pregnancy

Other resources:

Perinatal Bipolar Mood Disorders: Postpartum Support International (PSI) provides an overview of bipolar disorder symptoms, risks during pregnancy and postpartum, treatment options, and support resources for pregnant and postpartum individuals.

Bipolar Disorder in the Postnatal Period: COPE (Australia) explains the impact of bipolar disorder on new mothers, the importance of early intervention, hospital care, and ongoing support after discharge.

Bipolar disorder, pregnancy and childbirth – Information for women, partners and families: An informational booklet published by Bipolar UK.

The MGH Center for Women’s Mental Health: Provides regularly updated, evidence-based information on the reproductive safety of psychiatric medications.

MotherToBaby Fact Sheets: Evidence-based fact sheets for patients about specific medications and their use during pregnancy and breastfeeding (searchable by medication name).

DailyMed: Provides the most up-to-date drug labeling (package inserts) for prescription and nonprescription drugs.  The database includes FDA-approved prescribing information, indications, dosage, warnings, adverse reactions, drug interactions, and use during pregnancy and breastfeeding.

Reliable Evidence-Based Information on Medications: Don’t Just Google. Please note that these resources are not intended to be a substitute for medical advice or care; they are intended to supplement your treatment and to help you make medially informed decisions.  Many other sites offer “Safe During Pregnancy” lists of medications; however, these lists are often incomplete and may also include over-simplified or inaccurate information. Decisions regarding the use of medications should be made in collaboration with your provider.

Screening for Bipolar Disorder in Pregnancy and the Postpartum

Treatment Guidelines

Antipsychotics and Pregnancy

I Have Bipolar Disorder. Can I Keep Taking My Meds While Pregnant?

The National Pregnancy Registry for Psychiatric Medications is dedicated to evaluating the safety of psychiatric medications such as antidepressants, ADHD medications, and atypical antipsychotics that many people take during pregnancy to treat a wide range of mood, anxiety, executive function, or psychiatric disorders. The goal of this Registry is to gather information on the safety of these medications during pregnancy, as current data is limited.

If you are pregnant and have taken an antidepressant, ADHD medication, or atypical antipsychotic, please click the participation information button above. Individuals with a history of psychiatric illness who are pregnant and have not taken an antidepressant, ADHD medication, or atypical antipsychotic are also welcome to enroll in the Registry.

TO PARTICIPATE CALL TOLL-FREE: 1-866-961-2388

All pregnant people 45 and younger with a history of psychiatric illness are eligible to enroll in the registry. If you are interested in participating in the National Pregnancy Registry, please call the toll-free number above or fill out this Participant Interest Form to be contacted by a member of our research team. All information is kept strictly confidential.

Considering the Risks of Untreated Illness in the Mother

When making treatment decisions during pregnancy, it is essential to weigh not only the potential risks of psychiatric medications but also the significant risks associated with untreated psychiatric illness in the mother. Untreated mood and anxiety disorders can have profound effects on both maternal and fetal health. For mothers, untreated illness may lead to impaired self-care, poor nutrition, increased substance use, and inadequate prenatal care, all of which can negatively impact pregnancy outcomes. There is also a higher risk of pregnancy complications such as pre-eclampsia and operative delivery,

The Policy Center for Maternal Mental Health provides a fact sheet outlining the risks of untreated maternal mental health disorders, including their impact on pregnancy outcomes and early childhood development.

Assembling a Multidisciplinary Healthcare Team

For women with bipolar disorder considering pregnancy or navigating the perinatal period, decisions about medication management require careful consideration of risks, benefits, and personal values. This process is deeply individual and should never be undertaken alone. Below, we expand on strategies for assembling a support system and accessing specialized resources to guide these complex decisions.

Effective care during pregnancy begins with a collaborative team of professionals who specialize in perinatal mental health.

Your psychiatrist or another qualified prescriber should serve as the cornerstone of this team, providing expertise on the use of medications during pregnancy.  Throughout the pregnancy and postpartum period, your prescriber will help you to monitor your symptoms and help you to make treatment changes, if needed. Even if you decide to stop your medications, having regular visits with a psychiatrist can help you to stay on track and to identify any problems early.

To help you find a knowledgeable prescriber, Postpartum Support International (1-800-944-4773) provides a directory of providers with expertise in perinatal mental health.

Your obstetrician will closely monitor your pregnancy and, when necessary, collaborate with your psychiatric prescriber to ensure coordinated care. Throughout your pregnancy, your OB will arrange for the appropriate tests and monitoring to safeguard both your health and your baby’s well-being. Unless complications or specific medical concerns arise, most women taking psychotropic medications do not require follow-up with a high-risk or maternal-fetal medicine specialist.

Therapists may provide additional monitoring of your mental health and may help to identify early signs or symptoms of relapse.  In addition, they may teach you coping strategies for stress management or offer specialized interventions, including cognitive-behavioral therapy (CBT), to manage depression, anxiety and sleep problems.

Sometimes things don’t work out with the healthcare providers you have chosen. They may be highly regarded by others, but if it doesn’t feel like a good fit for you, it’s OK to seek a second opinion.  You should consider seeking out a different provider if you feel that your provider is not listening to or is dismissive of your concerns.

Engaging Personal Support Networks

While medical professionals provide clinical guidance, personal support systems offer emotional scaffolding. Partners, family members, and friends can:

• Serve as a sounding board and help you to make decisions regarding your care during pregnancy and the postpartum period.
• Attend medical appointments to help you to communicate concerns and understand complex clinical information.
• Track early warning signs of mood shifts, such as decreased sleep or racing thoughts.
• Share nighttime newborn care to lessen sleep deprivation, a key trigger for relapse.

However, familial relationships are complicated; some women with bipolar disorder report that unsupportive family dynamics exacerbate stress during pregnancy and the postpartum period.  In these cases, trusted friends or community organizations can help to fill in the gaps.

Guidance for Family Members: The International Center for Bipolar Disorders has created this information sheet to help family members know how to best support moms during the perinatal period.

Leveraging Specialized Peer Support Groups

Online communities bridge the isolation often felt when making medication decisions about pregnancy and navigating the perinatal period.

• The International Bipolar Foundation and Postpartum Support International (PSI) jointly offer a Bipolar-Specific Perinatal Group: These peer-led sessions connecting participants from pregnancy through two years postpartum.
• The Depression and Bipolar Support Alliance (DBSA) supplements these offerings with identity-focused groups, including sessions for LGBTQ+ parents and rural residents.