Bipolar disorder (BD) affects about 4.4% of the US population and often relapses with episodes of mania, hypomania, and depression. Women are particularly vulnerable during pregnancy and postpartum, with increased risks for rapid cycling, mixed states, and postpartum depression or psychosis. Early identification and differentiation from unipolar depression using tools like the Mood Disorder Questionnaire (MDQ) alongside EPDS or PHQ-9 are essential. Obstetricians play a key role in screening and initiating care when psychiatric services are limited, especially during high-risk postpartum periods.

Pharmacotherapy is the primary treatment for BD during pregnancy and lactation. Mood stabilizers like lithium and lamotrigine require careful dosing and monitoring due to pregnancy-related metabolic changes. While lithium carries a small risk of congenital heart defects, it remains effective with appropriate management. Lamotrigine is generally well-tolerated and safe. Second-generation antipsychotics are also used, with attention to weight and dose adjustments. Bright light therapy and electroconvulsive therapy provide effective adjunct options, particularly for treatment-resistant cases. Coordinated care and ongoing monitoring are essential to balance maternal mental health with fetal and neonatal safety.

Reference: Clark CT, Wisner KL. Treatment of Peripartum Bipolar Disorder. Obstet Gynecol Clin North Am. 2018 Sep;45(3):403-417. doi: 10.1016/j.ogc.2018.05.002. PMID: 30092918; PMCID: PMC6548543.