Pregnancy and bipolar: I’m pregnant! What do I need to know?


Pregnancy usually a happy time for any would-be mom. But bipolar can complicate the situation considerably. It is important to educate yourself if you have a bipolar diagnosis and are either planning to get pregnant or have discovered you are pregnant already.

In women, the peak period of severe bipolar symptoms occurs between 12 and 30 years of age which represents a large portion of a woman’s reproductive years.

Much of the focus when it comes to pregnancy and bipolar is on the risks associated with the use of mood stabilisers on foetal development. While this is obviously important, there are many other factors to consider regarding pregnancy and bipolar.

However, most women with bipolar disorder have a healthy pregnancy and baby.

Read on to find out all you need to know about pregnancy and bipolar.

The issue of bipolar medication and pregnancy

Treating pregnant women with bipolar has been described as “one of the most challenging clinical endeavours”. The authors of this 2015 scientific review write that “[p]atients and clinicians are faced with difficult choices at every turn, and no approach is without risk”.

On the one hand, stopping effective medication during pregnancy may expose both the mother and her baby to “potential harms related to bipolar relapses and residual mood symptoms-related dysfunction”.

On the other hand, continuing with the use of medication during a pregnancy – especially mood stabilisers – has been associated with congenital malformations and other adverse effects in unborn babies.

The risks of using traditional bipolar medications during pregnancy

There are significant risks for unborn babies associated with the use of conventional bipolar drug therapy – mood stabilisers. Below is a summary of the risks associated with the four commonly-used mood stabilisers.


  • 2.8% risk of major congenital malformations
  • Risk of Ebstein’s anomaly (a congenital heart defect): One case per 1000 – 2000 live births
  • Reported cases of other neonatal complications


  • 5 – 11% risk of major congenital malformations which is the highest risk of all mood stabilisers and this rate increases when valproate is combined with other anticonvulsants
  • Increased risk of adverse neurodevelopmental outcomes


  • 2 – 6% risk of major congenital malformations
  • Several adverse neonatal events from birth defects reported


  • 2.8% risk of major congenital malformations

The risks of not treating bipolar with effective drugs during pregnancy

While the risks associated with bipolar drugs are well-documented, so are the risks associated with untreated bipolar disorder in pregnancy. Bipolar cases differ substantially in terms of symptom severity and many women with bipolar may not be at risk of engaging in dangerous behaviours. These risks include behavioural risks that accompany acute episodes of mania or depression such as:

  • Impulsive and risky behaviours
  • Unplanned pregnancy
  • Substance use and abuse
  • Poor adherence to prenatal care
  • Disruptions in support structures and family functioning
  • Maternal suicide (which is a leading cause of mortality in mothers in the period of a year after giving birth)

Alternative lower-risk therapies for pregnant women

Psychotherapy is an option but, by itself, it does not effectively treat many cases of bipolar disorder.

Atypical antipsychotics have become a more popular choice as replacement therapy for mood stabilisers for pregnant women and have shown promise in treating mania in particular. They have been found to be less dangerous to a developing foetus although the extent of the risks are still not fully known.

Another option which has been used successfully for pregnant women with bipolar is electroconvulsive therapy (ECT). Research shows that there is a positive response to 84% of cases with a mood disorder treated with ECT.

Additionally, it is “a rapid and effective treatment modality that can be safely administered during pregnancy”. The main barriers to using ECT is negative social stigma and cost.

The authors of a 2017 scientific research paper note that “ECT sounds ominous and has a negative reputation because it involves passing electricity into the brain to cause a seizure” and this perception has been fuelled by how ECT has been represented in popular media.

Post-partum risks and considerations

Women with a bipolar diagnosis have a one in four chance of suffering a severe recurrence of symptoms following delivery. As such, women should be closely monitored and provided with treatment immediately after they have given birth.

Post-natal depression is also a significant risk for women with bipolar.

General association between bipolar and pregnancy complications

Generally, a bipolar diagnosis has been associated with other pregnancy complications. According to data from Australia, Taiwan and Sweden, women with bipolar are more likely than those without the disorder to experience:

  • Placental abnormalities
  • Antepartum haemorrhages
  • Toxicities related to alcohol, tobacco and illicit-substance use
  • Low birth weight
  • Preterm birth
  • Caesarean section delivery

Substance abuse during pregnancy is higher in women with bipolar regardless of whether they are receiving treatment or not and addiction treatment is recommended for affected women.

In this blog we have provided a detailed description on the risks associated with bipolar and pregnancy. While it is important to be educated about the risks so you are in a position to make informed decisions, it is important to note that most women with bipolar have a healthy pregnancy and baby. Pregnancy is, however, a more risky time for women with a bipolar diagnosis than for those without one.

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