Pregnancy and Postpartum

John McManamy Health Guide
  • My daughter Emily is one trimester away from making me a grandfather. Naturally, I can’t help but think about the obvious elephant in the room. My daughter doesn’t have my diagnosis, but she did inherit half my genes. No doubt, she will be fine, but I have reminded her of the potential risk.

    Pregnancy issues loom large throughout this site. It starts with the burning question: “Should I have kids?’ I was blissfully ignorant of my diagnosis when Emily was conceived, and thank heaven for that. Knowing you’re the proud donor of genes from hell has a way of making you think.

    The good news is the risk of your child inheriting your illness is about one in five, which goes up if both parents have bipolar. The other good news is bipolar is not a death sentence. Managed right, your kids can lead highly satisfying and even enviable lives.

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    The major issue is the same one normal parents ask themselves: Can I handle raising a kid? Bipolar poses its special challenges, but it is not an automatic disqualification. Nevertheless, some woman may have to choose in violation of their own natural maternal instincts - I cannot begin to imagine how painful this decision must be.

    Are meds safe during pregnancy? is the next question in the sequence. Unfortunately, the question tends to be asked only when a woman finds out she is going to be a mother, five or six weeks into the pregnancy. By this time, a lot of critical fetal development has already taken place.

    The time to be asking this question is BEFORE conception. Several years ago, at an APA conference, I heard Zachary Stowe MD of Emory University speak extensively to this issue. The rate of birth defects for women on psychiatric meds is one in 11, he said, with the danger period in the first trimester, especially for lithium and the anticonvulsant mood stabilizers.

    No decision is risk-free, Dr Stowe advised. Those thinking of going off their meds need to consider that maternal depression can result in higher rates of alcohol and substance use, poor self-care, nutrition, and sleep, plus pre-term labor and babies with lower birth weights and developmental deficits.

    Those who choose to go off their meds may consider other options such as talking therapy, omega-3 and light therapy. Even ECT is not out of the question.

    It is prudent to get back on a mood stabilizer in the second and third trimesters, Dr Stowe advised. Being stabilized prior to giving birth is critical. All hell is about to break loose, and the risk for postpartum relapse skyrockets.

    Motherhood itself is a major stressor, tending to be accompanied by lack of sleep, social isolation, and adjustments to life-changing routines. Careful planning is vital. Make sure your partner is on the same page as you, have your support network in place, and don’t be afraid to reach out.

    A few days ago, Emily emailed me a jpeg of herself. She was always a beauty, but this time she radiated. For you moms-to-be, this is a precious time in your life, full of hope and anticipation. New dads, too. Preparing for the worst enhances your odds for the best. Carefully consult with your family doctor and your psychiatrist, and remember - there are no right or wrong decisions, only informed and uninformed ones.

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    Further reading: Katherine Stone has a terrific blog, Postpartum Progress.

Published On: July 24, 2009