Polypharmacy and Discontinuation of Medication during Pregnancy in Women with Bipolar Disorder: Implications for Maternal Health

Bipolar disorder is a chronic and severe psychiatric condition.

Treatment recommendations for pregnant women with bipolar disorder focus primarily on the potential risk of medication exposure on the health of the fetus and neonate. However, the health of the mother is of concern as well.

Women with bipolar disorder have an increased risk for complications during pregnancy and postpartum, and there is little or no research on how to manage their medication to best avoid relapse, toxicity, and somatic complications.

Data from the Swedish and Norwegian national health registers including the Medical Birth Registers, the National Patient Registers, and Prescribed Drug Registers will be used to identify all pregnancies in women with bipolar disorder from 2006 to 2020 and the medication they used before, during, and after pregnancy.

Novel methodologies in pharmacoepidemiology will be applied to investigate the patterns of medication use in pregnant women with bipolar disorder, including the extent to which polypharmacy occurs, whether there is risk for harmful drug-drug interaction, and how often women discontinue their medication during pregnancy.

In women who discontinue their medication, the risk for obstetrical and neonatal complications and adverse psychiatric events including relapse, postpartum psychosis, and self-harm will be assessed compared to women who continue medication throughout pregnancy.

The study population will be stratified into clinically relevant groups according to pre-pregnancy stability and use of lithium to help account for confounding by indication.

Other important confounders such as, co-medications and comorbidities will be identified and adjusted for using state of the art analysis methods including propensity scores.

Results from these studies will provide evidence for treatment guidelines in pregnancy for women with bipolar disorder and will help women and their clinicians make important decisions about medication use during pregnancy.