For pregnant women, much thought goes into maintaining the complementary balance of maternal health and healthy fetal development. For women with bipolar disorder, this balance includes risk/benefit considerations for both mother taking psychotropic medications and developing infant. To improve the outcomes of these complicated pregnancies is an urgent goal, as the results of this research would support two generations.
The overall risk of recurrence of depression or mania for women with bipolar disorder can be as high as 71% during pregnancy. The rates of recurrences are highest for women who discontinue their medications, and even those who continue their medications often experience recurrences. Although the risks are quite small, birth defects are another concern for prospective mothers. However, untreated bipolar disorder also bears great perinatal risk for mother and child.
We looked at the Prechter Program's database and reviewed obstetric outcomes for 245 women with bipolar disorder. These women reported 646 pregnancies. Those who included information on the results of those pregnancies reported 365 live births and 167 pregnancy losses.
These data make it clear that pregnant women with bipolar disorder face extremely difficult decisions related to their psychiatric care as well as significant concerns about obstetric and fetal safety. These data highlight the importance of integrated care among obstetricians, psychiatrists, and primary care providers, as well as the importance of considering alternative or complementary treatments to decrease recurrences and increase positive obstetric outcomes.
Future research goals:
- Use MOODS of Moms data results to conduct focus groups. Invite survey respondents to participate; discuss coping strategies that these women used during pregnancy, including alternative treatment interventions they actually used or would have considered.
- Use focus group and pilot data to design a feasibility study investigating complementary and alternative strategies to prevent recurrences of manic or depressive episodes during pregnancies for women with bipolar disorder. This will be an interventional research project, comparing non-pharmaceutical treatments such as yoga, exercise, and mindfulness as complementary or alternative treatment for pregnant women with bipolar disorder.
The investigative team on the MOODS of Moms study brings much pertinent research experience to this study. Principal investigator Dr. Rich Dopp has focused his research on relationships among depression, bipolar disorder, sleep, and metabolism. His study on exercise and adolescents with mood disorders showed significant reductions in depression severity (Dopp et al., 2012). Dr. Dopp is currently conducting exercise research for adolescents with, or at risk for, bipolar disorder; his program manager for this exercise study, Ann Mooney, M.S.W., is also the research coordinator for this MOODS of Moms research. Dr. Melvin McInnis, principal investigator of Prechter Bipolar Research Program, has research expertise and invaluable clinical experience with this psychiatric population. Dr. Leslie Swanson has extensive research experience with women with perinatal mood disorders as well as studies utilizing medical chart review data (Swanson et al., 2011). Dr. Deborah Berman contributes her expertise as an obstetrician and researcher to broaden the perspective of this interdepartmental team. Consultant Dr. Maria Muzik, Director of the Women and Infants Mental Health Program, has conducted research including investigations of mindfulness yoga during pregnancy for women at risk for psychiatric illness (Muzik et al., 2012).
The initial phases of this research program were covered under HUM#00000606 and HUM#00140958.
Read more about the MOODS of Moms study in a news item here.