Bipolar disorder during pregnancy and the postpartum period: Patients considerations, course of bipolar disorder and impact of sleep loss: Patients considerations, course of bipolar disorder and impact of sleep loss

The aim of this thesis was to study the course of bipolar disorder (BD) in pregnant women and the influence of sleep during pregnancy and the peripartum period on the development of postpartum mood symptoms. Importantly, we also wanted to explore considerations of women with BD about family planning and pregnancy.
Main findings

What are thoughts and considerations of women with bipolar disorder about family planning and pregnancy? A qualitative study of 15 childless women with BD I revealed that they worried about heritability of BD, had questions about medication use during pregnancy, and were fearful of recurrence of a mood episode during pregnancy or postpartum. In addition, these women feared to be incompetent as a mother during future mood episodes and mentioned that support of their partner, social network, and mental health providers is essential.
What is the impact of medication on the course of BD in pregnant women?
One of the conclusions of our systematic review about the impact of continuing maintenance medication on the recurrence of mood disorders during pregnancy is that the 22 included studies reported a wide range in the recurrence rate of BD and major depressive disorder, from 4 to73%. Another conclusion is that maintenance pharmacotherapy during pregnancy in women with mood disorders significantly reduced the risk of recurrence (66% in BD and 54% in major depressive disorder).

What is the effect of perinatal sleep disturbance on postpartum mood in women with BD?
The study protocol of the Sleepreg-bd study is described. Mood and sleep was monitored during weeks 26, 38, 39, and 40 of pregnancy, the first four weeks postpartum, and finally in week 12 postpartum. Assessments consisted of self-report questionnaires and objective (actigraphy) and subjective (diary) sleep measures. We did not find an association between objective sleep disturbance in the perinatal period on postpartum mood symptoms in women with BD. In healthy sleepers, i.e., women who slept 7-9 hours/day, poor sleep efficiency in the first week postpartum was predictive of hypomanic mood symptoms in the second week postpartum. The strongest predictor for postpartum mood symptoms was having mood symptoms in the second trimester of pregnancy.

Does the course of bipolar disorder differ in pregnant women versus non-pregnant women?
We compared the course of BD in a cohort of 34 Dutch pregnant women from the Sleepreg-bd study to the course of BD in a cohort of 52 Dutch non-pregnant women who participated in the Stanley Foundation Bipolar Network (SFBN) Naturalistic Follow-Up Study using scores of the Lifechart Method (LCM). No differences were found in several clinical BD course variables (symptomatic days, average severity scores, frequency, and duration of episodes) between pregnant and non-pregnant women. Looking beyond these parameters, with a combination of State Sequence Analysis (SSA) and cluster analysis on the sequences of daily mood scores on the LCM we discovered three comparable clusters: a euthymic, a moderately ill, and a severe ill cluster. The distribution differences between pregnant and non-pregnant women were significant, with a majority of the pregnant women (68%) belonging to the moderately ill cluster and a majority of the non-pregnant women (46%) to the euthymic cluster.

What about men? We present the case of a man with BD who had a manic episode immediately after the birth of his child. We argued that in this case several risk factors coincided: sleep loss due to a long, night-time delivery, subsequent sleep deprivation due to the irregular sleep pattern of the baby, and the major life event of becoming a father. This case study underscores the need to also pay attention to men with BD who become fathers.