American singer-songwriter Selena Gomez may have anxieties about conceiving and becoming a mother because of the medication she takes for her bipolar disorder but many in her condition are birthing children around the globe. And if experts are to be believed, then a woman with bipolar disorder can become a mother with the right guidance and monitoring.
“With the rise in bipolar disorder cases in India, there has been a misconception among the masses that medications related to it are harmful for the baby in pregnancy or can result in infertility or a decrease in the chances of conception of a baby. While it is possible to get pregnant even though a patient is diagnosed with bipolar disorder and taking medication for it, the baby and the mother can be led through the birthing process with a specialist’s help each step of the way,” says Dr Gunjan Gupta Govil, founder and chairman, Gunjan IVF World Group. She has had many clients who have successfully delivered babies despite being on anti-psychotic drugs. Some of them have even approached her for IVF (in-vitro fertilisation) procedures. “What is essentially needed is a multi-disciplinary approach, where a regime is devised in consultation with the psychologist, psychiatrist, gynaecologist and any other specialised practitioner depending on the would-be mother’s health condition,” she adds.
How harmful are anti-psychotic drugs?
The problem with sweeping generalisations by celebrities is that people start believing in them quickly rather than go by medical logic. “What people need to know is that the newer generation of anti-psychotic drugs are far safer than those used previously. The use of lithium is much minimised and mental health professionals usually try to limit its use further on women who are looking to become mothers. These newer generation drugs have not caused any damage to babies born to mothers battling bipolar disorder. Still, if there is an outside chance of malformation, we can monitor the babies with specialised scans and genetic scans for structural abnormalities. In fact, if a woman’s mental curve is stable and she can keep off medication the first trimester, there’s no need to worry at all. Even if she resumes her medication from the second trimester, the baby is safe as major organs have mostly been formed by then,” says Dr Govil.
In fact, a 2015 research paper, published in pubmed.gov, says, “Given the potential harm of not treating severe psychiatric illnesses during pregnancy, careful administration of anti-psychotics is recommended for pregnant women who suffer from severe mental disorders. The most frequently used antipsychotics in pregnancy are olanzapine, risperidone and quetiapine, and do not appear to cause consistent, congenital harm to the foetus. No specific patterns of foetal limb or organ malformation related to these drugs have been reported. There is some evidence suggesting an association between antipsychotic use in pregnancy and the development of gestational diabetes.”
Should a woman with bipolar disorder planning a baby stop her medication?
This, according to Dr Govil, is tantamount to self-harm and does more damage to the mother and baby. Untreated mental health conditions have been linked in some studies with low birth weight and negative effects on developing brain structures in the baby. For some women, stopping a medication is a greater risk for herself and the new life she is carrying than any imagined risk as she plunges to new troughs. “That’s why I emphasise specialist care. Psychiatrists with expertise in women’s health issues advise continuing certain psychiatric medicines during pregnancy along with regular screening of the developing foetus,” she says.
At no stage should women stop medication voluntarily as they can suffer withdrawal symptoms like mood swings, anxiety, depression, headaches and most importantly have a relapse. According to a 2007 study in the American Journal of Psychiatry, women who discontinued mood stabilizers during pregnancy spent over 40 percent of their pregnancy in an “illness episode.” And research suggests that the effects of maternal depression on the foetus can lead to complications both during and after pregnancy.
How do women with bipolar disorder plan for conception?
There has to be discretionary use of medication depending on the severity of the condition in women looking to be mothers. “If somebody has a steady mental graph for a certain period of time, then she may be weaned off medication in consultation with the mental healthcare professional and given 5 mg of folic acid daily. If psychotic symptoms are severe, then the woman needs to continue to be on medication even during conception. It is most important to prioritise the health and well-being of the mother. Only then will she be able to give birth to a healthy child,” advises Dr Govil.
How to deal with post-partum symptoms in mothers with bipolar disorder?
As a woman’s body goes through major hormonal changes after delivery, mothers with bipolar disorder are generally more prone to post-partum psychosis. “So they should be kept under monitoring, counselled by a clinical psychologist, given medication, and supported by the family and self-help groups. She can lactate while being on medication, so no worries there,” says Dr Govil.
Women with bipolar disorder should also build a wellness routine of a healthy diet, adequate hydration, yoga and meditation to keep her feel-good state, she recommends. The only other health concern to watch out for, she says, is gestational diabetes among bipolar mothers as the medication makes them more susceptible to it. “Some monitoring can take care of that,” she adds. “In the end, it’s about a health management plan like any other condition.”