Departments of Psychiatry and Obstetrics & Gynecology, University of Western Ontario, London, Canada.
Parkwood Institute Mental Health, London, Canada.
Expert Rev Neurother. 2020 Apr;20(4):373-383. doi: 10.1080/14737175.2020.1743684. Epub 2020 Mar 19.
: Despite increased interest in the pharmacotherapy of bipolar disorder during pregnancy and the postpartum period, management of the disorder during these critical periods in a woman's life remains challenging.: The authors review the effect of pregnancy and the postpartum period on the course of bipolar disorder, describe adverse pregnancy and birth outcomes, and discuss the pharmacotherapy of bipolar disorder during and after pregnancy.: When treating women with bipolar disorder of childbearing age, clinicians should consider the possibility of pregnancy. Pre-conception counseling should be an integral part of the overall plan to manage bipolar disorder during and after pregnancy. Peripartum management of bipolar disorder is challenging and requires balancing of risks associated with the use of drugs and the potentially deleterious effects of untreated bipolar disorder on the fetus/child. Formulation of personalized treatment requires knowledge of both current (episode type, symptom severity, psychiatric comorbidity, and safety concerns) and historical (episode frequency, response to drugs and psychotherapy, and the effect of reproductive events including pregnancy and postpartum period) factors. Close monitoring is essential for early detection and management of mood episodes. Routine safety assessments are necessary to identify women at risk of harming themselves or the newborn.
尽管人们对妊娠期和产后期间双相情感障碍的药物治疗越来越感兴趣，但在女性生命中的这些关键时期管理该疾病仍然具有挑战性。作者回顾了妊娠和产后期间对双相情感障碍病程的影响，描述了不良的妊娠和分娩结局，并讨论了妊娠期和产后期间双相情感障碍的药物治疗。在治疗育龄期双相情感障碍女性时，临床医生应考虑怀孕的可能性。孕前咨询应作为管理妊娠期和产后期间双相情感障碍的整体计划的一个组成部分。围产期双相情感障碍的管理具有挑战性，需要平衡与药物使用相关的风险以及未经治疗的双相情感障碍对胎儿/儿童的潜在有害影响。个性化治疗方案的制定需要了解当前（发作类型、症状严重程度、精神共病和安全问题）和既往（发作频率、对药物和心理治疗的反应以及包括妊娠和产后期间在内的生殖事件的影响）因素。密切监测对于早期发现和管理情绪发作至关重要。有必要进行常规安全性评估，以识别有自残或伤害新生儿风险的女性。
