Bipolar Disorder in Pregnant and Postpartum Women

Final Annotated Bibliography: Bipolar Disorder in Pregnant and Postpartum Women

Carly Janine

Questions: How does Bipolar Disorder affect women’s health through pregnancy and child-rearing? Should anti-psychotics, anti-depressants, and mood stabilizers be taken while pregnant? What options are there for pregnant women with bipolar disorder? Can bipolar disorder be properly treated while pregnant? In what ways can we support women with bipolar disorder who are going through pregnancy and child-rearing?

  1. Topic: I am trying to learn about bipolar disorder in pregnant women and postpartum outcomes and solutions
    • Question: because I want to find out whether current useful research is being done, what further research is needed
      • Significance: in order to help my reader understand how best to support women with bipolar disorder in pregnancy and to improve postpartum outcomes.

This subject is very near and dear to my heart. I was diagnosed with Bipolar Disorder Type 1 in 2013, at age 32. My sweet daughter was three years old at the time. Personally, having a diagnosis made things a lot easier for me and with medication, things became manageable. As I reflect upon my pregnancy and my mood swings at the time, I wonder how I could not have known, and if I had known, what I would have done. It made me curious what others do, as it seems there is often a lot of debate on the online bipolar community forums about whether we should have children, and if so, whether we should come off of our medications in order to do so.  Common misconceptions about people suffering from Bipolar Disorder include stereotyping them as irresponsible, sexually promiscuous, unstable.  Researching this topic has been both personally satisfying and frustrating for me, as I realize there is still so much more research to be done and support to be offered. I have done my best to offer up the most useful sources I could find relating to the topic of bipolar disorder in women, particularly women going through pregnancy, childbirth, and postpartum depression and mania.

The criteria I used to evaluate my sources was a blend of several evaluation styles we learned in Week 3. I used the questions from the Curious Ways of Knowing, the checklist from Excelsior College, and the Rhetorical sheet although I relied heavily on the questions from the Curious Ways of Knowing for evaluating all of my sources.

 

Bodén, R., Lundgren, M., Brandt, L., Reutfors, J., Andersen, M., & Kieler, H. (2012, November 8). Risks of adverse pregnancy and birth outcomes in women treated or not treated with mood stabilisers for bipolar disorder: population based cohort study. The BMJ, 345(e7085). Doi:10.1136/bmj.e7085

(URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3493986/)

This article follows a study based in Sweden that determined women with Bipolar Disorder face increased risk of adverse pregnancy outcomes. The primary findings of this study state that treatment of Bipolar Disorder involves risk management. This study in particular adds that infants of women with Bipolar Disorder had increased risks of “preterm birth, irrespective of whether the mother had received mood stabilising drugs” and that “infants of women with untreated bipolar disorder had also increased risks of microcephaly and neonatal hypoglycaemia.”

I evaluated this scholarly source by using the Way of Curious Knowing questions primarily. I determined this to be a “Source by Scholars” and the methodology used in the study seemed to make sense. A group of women diagnosed with Bipolar Disorder were studied throughout their pregnancies and the outcomes of those pregnancies was recorded. Missing from this study is a comparison including drug use and Bipolar Disorder and pregnancy all together, which would be helpful in future charting. The study was funded by grants, and the authors include researchers, a psychiatrist, pediatrician, gynecologist, and a biostatician. The professional expertise of the authors, combined with their efforts to get this research funded, convinced me that they were a reputable source to include. It was published in 2012 by BMJ.

 

Cook, C. L., Flick, L. H., Homan, S. M., Campbell, C., McSweeney, M., & Gallagher, M. E. (2010). Psychiatric disorders and treatment in low-income pregnant women. Journal Of Women’s Health (15409996), 19(7), 1251-1262. Doi: 10.1089/jwh.2009.1854

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This study, published in 2010, took place in the USA. 744 low-income women in Missouri were studied over the course of 12 months, of whom approximately 30% had mental illness. A shocking number of women were completely untreated for their mental illnesses during that year, and bipolar disorder was represented in about 5% of the women. This study found that there is a dire need for comprehensive mental health screening during pregnancy, as well as more treatment options and accessibility for low-income women.

All of the authors contributing to this study are PhDs. One of the limiting factors in this study is that they chose only to include applicants who can speak English. I would like to see a version of this study run again in which all eligible women could participate, perhaps with the aid of translators and really refine the research. However, overall, I was very impressed with the methodology displayed in this study and it is a primary research article based in the USA, which I appreciate. I would like to see more studies of this kind in more cities as this one is already eight years old. It was funded with research money from the National Institute of Mental Health.

 

Harwood, D. (2017). Birth of a new brain: Healing from postpartum bipolar disorder (pp.1-212). New York, NY: Post Hill Press.

 

This book, written by Dyane Harwood, details her experience firsthand with Postpartum Bipolar Disorder. It includes a wealth of information, including its own appendixes and recommended reading list. I was lucky enough to connect with this author on Twitter after posting about searching for sources on Postpartum Bipolar Disorder. Published in 2017, it is recent and all-encompassing as told by the patient’s point of view from postpartum onset and her diagnosis, to present day. Harwood was so excited to have someone studying what she had just written about that she sent me a copy of her book and I enjoyed it very much.

Dyane Harwood is a writer in Santa Cruz, CA. She has contributed to many mental health websites, magazines, and now has written a book detailing her experiences with Postpartum Bipolar Disorder. The strength of this source lies in it being firsthand experience, and it also included a foreword by Dr. Carol Henshaw, a psychiatrist familiar with Harwood’s case. Being a firsthand experience type of source, its weakness lies in that it is one person’s experience.

 

Miller, L. J., Ghadiali, N. Y., Larusso, E. M., Wahlen, K. J., Avni-Barron, O., Mittal, L., & Greene, J. A. (2015, April). Bipolar disorder in women. Health Care for Women International, 36(4), 475-498. Doi:10.1080/07399332.2014.962138

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This lengthy article on Bipolar Disorder in Women acts as a summary of research relating to the clinical care of these women. It includes a multitude of facts and statistics and boasts its own extensive bibliography of research for further study. It was interesting to see a collection of USA-based researchers after finding so many articles published in other countries. Despite not having conducted their own study, I found this research to be valuable and worth sharing.

The authors of this piece are seven psychiatric researchers from reputable schools, and their methodology in conducting their research seems spot-on to me. I was hesitant at first to include this source, despite it being scholarly and peer-reviewed, because they did not conduct their own study. However, I would be curious to know more about the statistics they used and to use their bibliography as a jumping point for future research. It is important to have current information, and I appreciate the efforts to get this paper out there in 2015, updating and making accessible a lot of research that was scattered around in databases. It was published by Health Care for Women International.

 

Minick, G., & Atlas, M. (2007, August). What’s the best strategy for bipolar disorder during pregnancy? [Electronic version]. Journal of Family Practice, 56(8), 665-668.

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This medical article appeared in the Journal of Family Practice in 2007 and covers strategies for coping with and treating Bipolar Disorder in pregnant women. While abbreviated, I found the medical information to be valuable and Dr. Minick goes into the advantages and disadvantages of using lithium and other medications. “Onset of bipolar illness often occurs in the teens and twenties, which puts women with bipolar disorder at risk for having episodes requiring treatment during their childbearing years.”

This article was, interestingly enough, written by an MD and a Librarian. I found this to be an intriguing combination. I found the contributions of both to be somewhat evident, although the medical findings generally dominated the article – they were well-organized. It also included a table with information pertaining to medications and side effects/contraindications. I would like to see an updated version of this article with a study attached covering a population of women with Bipolar Disorder. I would also like to see more doctors involved with this type of research. This article was published in 2007 by the Journal of Family Practice, which seems to be a medical journal.

 

National Collaborating Centre for Mental Health, (2006). Bipolar disorder: The management of bipolar disorder in adults, children and adolescents, in primary and secondary care (pp. 1-596). England: British Psychological Society. Retrieved from PubMed Health (21796830)

(URL: https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0015261/)

This seriously dense book is available in its entirety as a PDF on PubMed Health, and I noticed you can also purchase it on Amazon for under $100. It is a book in a series on psychological issues, and it includes vast amounts of information, including the treatment of pregnant and postpartum women with Bipolar Disorder. Overall treatment plans are included, as are trees advising whether the tapering of lithium or switching to antipsychotics is advised while the patient is pregnant or trying to become pregnant. I was so happy to find this source available for download.

Published in 2006, it would be great to see an updated version of this book. However, in searching for sources I found this one to be vetted. It includes pages and pages of references itself, and goes into treatment for children, as well, which is hard to find and very relevant to mothers that suffer from Bipolar Disorder, as there is a risk of their children being diagnosed with it as well. It was difficult to decipher the author of this book, as it seems to come from a group of people, the National Collaborating Centre for Mental Health. Within the text, many authors are listed with varying credentials, all seeming to be professors, researchers, doctors, and similar.

 

Nguyen, T. N., Faulkner, D., Allen, S., Hauck, Y. L., Frayne, J., Rock, D., & Rampono, J. (2010). Managing pregnant women with serious mental illness: using the Edinburgh Postnatal Depression Scale as a marker of anxiety and depressive symptoms. Australian & New Zealand Journal Of Psychiatry, 44(11), 1036-1042. Doi: 10.3109/00048674.2010.503185

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In this study conducted in Western Australia, 48 women with serious mental illness were treated by a team of caregivers. “The clinic has a multidisciplinary team, which comprises a midwife, a general practitioner/obstetrician, a psychiatrist and a social worker, all with sessional capacity, who come together during the running of the weekly outpatient clinic.” Many of the women in the study suffered from Bipolar Disorder, and all women who participated in the study gave birth between 2007 and 2009. Their methods seem solid, in that they attempted to keep track of the anxiety experienced using the Edinburgh Postnatal Depression Scale and gestational outcomes using control groups and statistical analysis.

I was unable to find out much about the authors of this study, but the fact that it was published in a peer-reviewed journal gives me confidence in it as a source. I would have liked to have seen more information on medications and the use of mood stabilizers in a study like this, so I would enjoy seeing an updated version of this study for today with many more participants.

 

Rusner, M., Berg, M., & Begley, C. (2016). Bipolar disorder in pregnancy and childbirth: a systematic review of outcomes. BMC Pregnancy & Childbirth, 161-18. Doi:10.1186/s12884-016-1127-1

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This article focused on nine research articles on Bipolar Disorder and used a narrative style to convey the synthesis of research. It includes many tables and statistics. It shows that there is a clear negative impact of Bipolar Disorder on pregnancy outcomes, including increased risk of medical interventions during labor and increased rate of caesarean section. Due to the fact that only nine studies were deemed inclusion-worthy, there is a lack of research on the control group of women with Bipolar Disorder that are not on mood stabilizers. Another article out of Sweden, I found the material to be a little overwhelming but ultimately helpful.

I appreciated the systematic approach to the overload of information there is out there on Bipolar Disorder. Their initial searches yielded over 2,000 articles, narrowed down to nine. I found the authors’ methods to be engaging, as they used narration to convey information. This is a scholarly article, and although no study was conducted by the primary researchers, I found them to be credible. This article was published in 2016 by the BMC Pregnancy & Childbirth journal.

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