Pregnancy and Breastfeeding in Bipolar Disorder: A Clinical Guide

Bipolar disorder (BD) poses unique difficulties in the context of reproductive transitions, particularly during pregnancy. The necessity for tailored treatment approaches to BD is underscored by sex differences, rates of misdiagnosis, and difficulties in treatment. Hormonal fluctuations have a significant influence on BD, and there is an increased risk of mood episodes during reproductive life events. Family planning in BD involves psychoeducation, addressing the individual’s concerns, and minimizing interactions between hormonal contraception and mood-stabilizing medications. Preconception consultations aim to address case-by-case risk factors and risks of in utero exposure to untreated mental illness versus medication, optimize medication regimens, and review available social supports. Unplanned pregnancies increase the likelihood of treatment discontinuation, a significant risk factor for perinatal recurrence, emphasizing the need for early counseling and prevention strategies. The care of perinatal BD also encompasses adjunct nonpharmacological interventions with a particular focus on psychoeducation, as well as psychotherapy, including cognitive-behavioral therapy and family-focused therapy. Sleep disruptions, which are commonly observed throughout pregnancy and significant after childbirth, increase the risk of BD episodes. Altogether, an individualized and multidisciplinary approach is essential for navigating the complexities of perinatal BD care.