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BIPOLAR PREGNANCY/NURSINGFor women with Bipolar Disorder and other mental illnesses, pregnancy is a subject that requires careful consideration. It is important for women of child bearing years to discuss pregnancy with both their partner and physicians. With proper care, a safe pregnancy for mother and baby is often possible. During pregnancy, the symptoms of many mental illnesses seem relatively inactive, but medications may still be necessary. The National Alliance for the Mentally Ill (NAMI) recommends the following guidelines for women who are planning pregnancy. These guidelines should be discussed with and approved by your physician. Stop using medications before trying to conceive, allowing a safety zone of one month before trying to conceive. Do everything possible during the first trimester of pregnancy to avoid medication, as it is the most critical time of fetal organ development. Any medication can put a fetus at risk, and there are specific risks for different medications. Anticonvulsants like Depakene and Tegretol, and sedatives such as Valium or Klonopin should be avoided. The use of anticonvulsants causes neural tube defects such as spinal bifida and anencephaly. Antipsychotic medications such as Haidol or Prolixin may be used only in small doses. Antidepressants are known to cause rare cases of infant distress such as congestive heart failure and respiratory disease. When used during the first three months of pregnancy, Lithium poses a high risk of heart malformation. In the third trimester, the use of Lithium has been associated with congenital hypothyroidism. If used at the end of the pregnancy, it may cause lethargic and listless babies with irregular suck and startle responses. However, Lithium is considered safe during the second trimester. A special consideration for women during pregnancy is that the use of Lithium may still be necessary for severe episodes of manic depression. Electroconvulsive therapy (ECT) is probably the safest way to treat severe depression in pregnant women. ECT can be used during any period of the pregnancy, but is less risky after the first trimester. The most common side effect is short term memory loss, and less frequent side effects include headaches, mild muscle soreness, irregular heartbeat, and adverse reactions to anesthetic or muscle relaxants. Women with mental illnesses are at a higher risk for postpartum difficulties, and it may be advisable to resume medication soon after delivery. Medications pose a risk for nursing infants, since most can be excreted in breast milk. Women should discuss with their physicians whether breast feeding is an option, or if bottle feeding will be necessary. There are benefits to breast feeding, but the most important factor is keeping the mother healthy to care for her new infant.
BY RICHARD SUTPHEN
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 BipolarConnection
2001 - 2008
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