1. Use of Mood Stabilizers and SGAs During Pregnancy
Flavio Guzmán, MD

2. Considerations in Bipolar Disorder

3. Balancing risks vs benefits
Before conception
Discuss with the patient and partner risks and benefits of pharmacotherapy
Bauer, M., & Gitlin, M. (2016). Lithium During Pregnancy and in the Postpartum Period. In The Essential Guide to Lithium Treatment (pp ). Springer International

4. Balancing risks vs benefits
Before conception
Discuss with the patient and partner risks and benefits of pharmacotherapy
Up to 50% of pregnancies are unplanned
Early discussion gives time to make informed decisions
Grover, S., & Avasthi, A. (2015). Mood stabilizers in pregnancy and lactation. Indian journal of psychiatry, 57(Suppl 2), S308.

5. Non-pharmacological treatment
No history of suicide attempts or frequent suicidal ideation
Prolonged periods of euthymia
Good social support
Close monitoring
Bauer, M., & Gitlin, M. (2016). Lithium During Pregnancy and in the Postpartum Period. In The Essential Guide to Lithium Treatment (pp ). Springer International

6. Maximize non-pharmacological treatments
Good social support
Regularity of sleep
Psychotherapy
Epstein, R. A.,et al. (2015). Treatment of bipolar disorders during pregnancy: maternal and fetal safety and challenges. Drug, healthcare and patient safety, 7, 7.

7. Monotherapy vs Polypharmacy
Recommended by guidelines
Polypharmacy
Increases overall teratogenic risk
Some patients require polypharmacy
Burt, V. K.,et al (2010). Bipolar disorder and pregnancy: maintaining psychiatric stability in the real world of obstetric and psychiatric complications. American Journal of Psychiatry.

8. General recommendations
Whenever possible, avoid valproate
Lithium and lamotrigine levels can fluctuate
Monitor mood stabilizers during treatment
“Half treatment” exposes the fetus to both the risks of treatment and maternal mental illness
Use effective doses
ECT is effective and relatively safe for severe or refractory symptoms
Epstein, R. A.,et al. (2015). Treatment of bipolar disorders during pregnancy: maternal and fetal safety and challenges. Drug, healthcare and patient safety, 7, 7.

9. General recommendations
Whenever possible, avoid valproate
Lithium and lamotrigine levels can fluctuate
Monitor mood stabilizers during treatment
“Half treatment” exposes the fetus to both the risks of treatment and maternal mental illness
Use effective doses
ECT is effective and relatively safe for severe or refractory symptoms
Epstein, R. A.,et al. (2015). Treatment of bipolar disorders during pregnancy: maternal and fetal safety and challenges. Drug, healthcare and patient safety, 7, 7.