Yonkers Kimberly A, Wisner Katherine L, Stowe Zachary, Leibenluft Ellen, Cohen Lee, Miller Laura, Manber Rachel, Viguera Adele, Suppes Trisha, Altshuler Lori
Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, USA.
Am J Psychiatry. 2004 Apr;161(4):608-20. doi: 10.1176/appi.ajp.161.4.608.
Bipolar disorder affects 0.5%-1.5% of individuals in the United States. The typical age at onset is late adolescence or early adulthood, placing women at risk for episodes throughout their reproductive years. General guidelines for the treatment of bipolar disorder are available from the American Psychiatric Association, but additional issues arise when these guidelines are applied in the treatment of peripartum women. The authors summarize knowledge regarding the management of bipolar disorder during pregnancy and the postpartum period, with a focus on managing mania, hypomania, and the psychotic components of the illness.
An expert panel reviewed articles that address the management of bipolar disorder and the consequences of the use of mood stabilizers during pregnancy, and a consensus document was generated.
The treatment of bipolar disorder in pregnant women involves significant challenges. Some mood stabilizers, e.g., sodium valproate and carbamazepine, are human teratogens. On the other hand, the teratogenicity associated with lithium may have been overestimated in the past.
Since treatment can be managed most effectively if pregnancy is planned, clinicians should discuss the issue of pregnancy and its management with every bipolar disorder patient who has childbearing potential, regardless of future reproductive plans. Additional research should address the risks of disturbed sleep to pregnant and postpartum women with bipolar disorder, as well as structural and behavioral consequences to offspring when mood stabilizers are used during pregnancy. Longitudinal and cohort studies can promote these efforts. Given the rate of bipolar disorder in the general population, research efforts will need to be broad based and include multiple collaborating centers.
双相情感障碍在美国影响着0.5%-1.5%的人群。典型的发病年龄为青春期末期或成年早期，这使女性在整个生育期都有发作的风险。美国精神病学协会提供了双相情感障碍的一般治疗指南，但在将这些指南应用于围产期女性的治疗时会出现其他问题。作者总结了关于双相情感障碍在孕期和产后管理的知识，重点是控制躁狂、轻躁狂以及该疾病的精神病性成分。
一个专家小组审查了关于双相情感障碍管理以及孕期使用心境稳定剂后果的文章，并生成了一份共识文件。
孕妇双相情感障碍的治疗面临重大挑战。一些心境稳定剂，如丙戊酸钠和卡马西平，是人类致畸剂。另一方面，过去可能高估了锂的致畸性。
由于如果计划怀孕，治疗可以得到最有效的管理，临床医生应该与每一位有生育潜力的双相情感障碍患者讨论怀孕及其管理问题，无论其未来的生育计划如何。进一步的研究应该关注双相情感障碍的孕妇和产后女性睡眠障碍的风险，以及孕期使用心境稳定剂对后代的结构和行为影响。纵向研究和队列研究可以推动这些工作。鉴于普通人群中双相情感障碍的发病率，研究工作需要广泛开展并包括多个合作中心。
