REVIEW OF: Masters et al, J Clin Psychiatry 2022;83(5):21r14045

STUDY TYPE: Systematic review and meta-analysis

The perinatal period is a time of increased risk for exacerbation of bipolar disorder. This new analysis tells us just how high that risk is. 

In the first systematic review and meta-analysis of 22 observational studies involving perinatal women, researchers looked at the prevalence of bipolar and bipolar spectrum disorders during pregnancy and postpartum. The total population was stratified into two categories: 1) participants without a known psychiatric history and 2) participants with bipolar disorder or probable bipolar disorder, assessed via a diagnostic interview or a diagnostic tool validated in perinatal populations.

Three studies looked at pregnant women, nine studies looked at postpartum women, and 10 studies looked at both. Less than half of the studies used diagnostic interviews to determine the presence of bipolar disorder, but all the studies at least employed screening tools validated in perinatal populations.

Among 6,325 women with no prior psychiatric diagnosis, about 3% developed bipolar disorder during the perinatal period. Among the 2,814 women already diagnosed with bipolar disorder, 55% had a mood episode during the perinatal period.

Compared to those without a prior bipolar disorder diagnosis, perinatal women who were identified with probable bipolar disorder on a screening test were 6.5 times more likely to experience a depressive episode. 

The main limitation was that only 45% of the studies looking at previously undiagnosed women used a structured interview to establish the diagnosis. Fifty-five percent relied on the Mood Disorder Questionnaire to establish the diagnosis.

CARLAT TAKE

When a woman shows signs of depression during or after pregnancy, be proactive about screening for bipolar disorder before initiating antidepressant therapy. One in five of these patients could potentially develop full-blown bipolar disorder. It’s worth noting that pregnancy significantly ups the ante for patients with existing bipolar disorder, amplifying the risk of fresh mood episodes by nearly seven times.

For  more on this topic, see The Carlat Hospital Psychiatry Report issue on Reproductive Psychiatry.