Pregnancy and Bipolar Disorder? Yes, You Can

by Natalie Feldman, MD, member of the Committee for Gender & Mental Health at the Group for the Advancement of Psychiatry

In the December issue of Rolling Stone, actress and musician Selena Gomez opened up about her experiences having bipolar disorder. She showed how, with the help of supportive mental health professionals, people with chronic mental illnesses can recover and thrive.

Some of the headlines following Selena’s interview, however, highlighted a popular misconception about using medications for bipolar disorder during pregnancy. People, for example, created a sensationalized headline: “Selena Gomez Says She May Not Be Able to Carry Children Due to Bipolar Disorder Meds." Moving beyond the hyperbole, there are, in fact, ways in which individuals with bipolar disorder can work with experts to plan for safe and healthy pregnancies and parenting.

One common misconception is that one needs to stop medication for bipolar disorder in order to safely be pregnant. This is not true. On the contrary, for those with bipolar disorder, stopping medications suddenly either before or during pregnancy may increase the likelihood of having a manic or depressive episode during or soon after pregnancy. Even decreasing a dose of medication without consulting one’s psychiatrist for feedback can cause problems; it translates into taking medication during pregnancy while not getting enough of it to maintain well-being. This is not only harmful to the pregnant person, but also to the baby, even before delivery.

Further, there are almost no psychiatric medications that are explicitly unsafe in pregnancy—valproic acid being a notable exception. Years of research have found that some medications may be safer in pregnancy than others, but most medications commonly used to treat bipolar disorder are compatible with having a safe and healthy pregnancy.

Although some medications can slightly increase the risk of certain conditions, such as a baby being born earlier or with a lower birth weight, having an active episode of bipolar disorder during pregnancy can increase the same risks while also increasing the risk of C-section and postpartum depression.

Balancing these risks and benefits is a complicated conversation that also needs to consider each person’s strengths, experiences, other medical conditions, and support.

For individuals with bipolar disorder, here are some things that can help achieve a successful pregnancy and parenting experience:

• Don’t stop medication. Many psychiatric medications are safe during pregnancy and breastfeeding. Check with an expert or see the information on LactMed or the Center for Women’s Mental Health at MGH.

• Plan ahead. Don’t wait until you’re pregnant; talk to a doctor before trying to conceive. A psychiatrist with reproductive mental health experience can help design a plan that works best for an individual person.

• Sleep is important to staying mentally healthy. Lack of sleep increases the risk of developing an episode of depression or mania for people with bipolar disorder. It may help to work out a plan with one’s partner or support system to get several unbroken hours of sleep per night, ideally at least four to six.

• Be thoughtful about the options for feeding the baby. There are many wonderful benefits to breastfeeding, and there is currently also a lot of pressure to breastfeed. The downside is that exclusive breastfeeding dramatically affects sleep, and as discussed above, that can make things especially difficult for someone with bipolar disorder. Taking into account all the risks and benefits of milk, formula, and getting enough sleep, it may be that formula supplementing or formula feeding is the best plan for your family.

• It takes a village. Gather support and resources. That may include partners, relatives, friends, and/or healthcare professionals such as therapists, psychiatrists, and more. Make a plan for how these people can be supportive through pregnancy and parenting.

Staying well enables one to be their best parent and partner. By planning ahead, working with experts, building a team, and creating a plan that works for the individual and their family, people with bipolar disorder can absolutely have successful pregnancy and parenting experiences.