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The management of bipolar disorder in the perinatal period and risk factors for postpartum relapse

Published online by Cambridge University Press:  15 September 2011

K. Doyle ,
J. Heron ,
G. Berrisford ,
J. Whitmore ,
L. Jones ,
G. Wainscott  and
F. Oyebode
K. Doyle
Affiliation:
Department of Psychiatry, Neuropharmacology and Neurobiology, University of Birmingham, Birmingham, UK
J. Heron*
Affiliation:
Department of Psychiatry, Neuropharmacology and Neurobiology, University of Birmingham, Birmingham, UK Perinatal Research Programme, Birmingham & Solihull Mental Health Foundation Trust, The Barberry, 25, Vincent Drive, Birmingham, B15 2QS, Birmingham, UK
G. Berrisford
Affiliation:
Perinatal Mental Health Services, Birmingham & Solihull Mental Health Foundation Trust, Birmingham, UK
J. Whitmore
Affiliation:
Perinatal Mental Health Services, Birmingham & Solihull Mental Health Foundation Trust, Birmingham, UK
L. Jones
Affiliation:
Department of Psychiatry, Neuropharmacology and Neurobiology, University of Birmingham, Birmingham, UK
G. Wainscott
Affiliation:
Perinatal Mental Health Services, Birmingham & Solihull Mental Health Foundation Trust, Birmingham, UK
F. Oyebode
Affiliation:
Department of Psychiatry, Neuropharmacology and Neurobiology, University of Birmingham, Birmingham, UK Perinatal Research Programme, Birmingham & Solihull Mental Health Foundation Trust, The Barberry, 25, Vincent Drive, Birmingham, B15 2QS, Birmingham, UK Perinatal Mental Health Services, Birmingham & Solihull Mental Health Foundation Trust, Birmingham, UK
*
*Corresponding author. Tel.: +00 44 121 301 2333. E-mail address:Jessica.heron@bsmhft.nhs.uk (J. Heron).
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Abstract

Aims

The perinatal period is a time of high risk of relapse for women with a history of bipolar affective disorder (BPAD). We describe the pregnancy management of women with BPAD and identify risk factors for postpartum relapse.

Methods

The case records of 78 women with BPAD referred to perinatal mental health services before conception, during pregnancy or the postpartum period, between 1998 and 2009 in Birmingham UK, were screened. In women who were managed during pregnancy, those who relapsed in the postpartum were compared with those who remained well.

Results

Forty-seven percent of women with BPAD referred in pregnancy suffered postpartum relapse. Women who were unwell at referral, younger, with unplanned pregnancy, previous perinatal episodes or a family history of BPAD were more likely to suffer postpartum illness.

Conclusion

Identifying risk factors for postpartum relapse enables us to individualise the estimation of a woman's risk and modify care plans accordingly. Duration of wellness prior to pregnancy is not associated with a lower risk of postpartum illness and so it is imperative that all women with BPAD receive referral in pregnancy.

Keywords

Bipolar disorderPostpartum relapseRisk factorsManagementPregnancyPerinatal psychiatry
Type
Original articles
Information
European Psychiatry , Volume 27 , Issue 8 , November 2012 , pp. 563 - 569
Copyright
Copyright © European Psychiatric Association 2012

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