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Pregnancy and Bipolar Disorder: A Systematic Review

J Clin Psychiatry 2012;73(11):1447-1455

Objective: The postpartum period is generally considered a time of heightened vulnerability to bipolar disorder; however, there is controversy about the effect of pregnancy on the course of bipolar disorder. This article reviews the literature on the relationship between pregnancy and bipolar disorder and suggests areas for future research.

Data Sources and Study Selection: Three electronic databases, MEDLINE (1966–2010), PsycINFO (1840–2010), and EMBASE, were searched on April 30, 2010, using the following keywords: pregnancy, bipolar disorder, manic depressive disorder, suicide, hospitalization, pharmacotherapy, and psychotherapy. The reference lists of articles identified were also searched. All relevant papers published in English were included.

Results: A total of 70 articles were identified and included in the review. Evidence from studies using nonclinical samples, some retrospective studies, and studies on psychiatric hospitalization rates is suggestive of a positive effect of pregnancy on bipolar disorder; however, recent studies conducted at tertiary care facilities have reported high rates of recurrence following discontinuation of mood stabilizers.

Conclusions: Understanding the relationship between pregnancy and bipolar disorder has implications for perinatal treatment and etiologic understanding of the disorder. Research is urgently needed to estimate the prevalence of bipolar disorder during pregnancy, using both clinical and nonclinical samples.

J Clin Psychiatry

Submitted: October 30, 2011; accepted May 22, 2012.

Online ahead of print: August 21, 2012 (doi:10.4088/JCP.11r07499).

Corresponding author: Verinder Sharma, MBBS, FRCPC, Regional Mental Health Care London, 850 Highbury Ave North, PO Box 5532, Station B, London ON N6A 4H1, Canada (