Bipolar disorder in pregnancy: medicines, planning and postnatal risk

The NHS describes bipolar disorder as extreme mood changes, with high periods of mania or hypomania and low periods of depression, usually treated with mood-stabilising medicine and talking therapies. Because relapse can be severe and the condition often lasts for life, planning ahead is the key to a safe pregnancy.

Tommy's stresses that most people with bipolar disorder have healthy pregnancies and babies. The aim of planning is to find the medicine arrangement that keeps you well while minimising risk to the baby, not to avoid pregnancy or to stop treatment.

It can seem safest to stop everything when you find out you are pregnant, but abrupt discontinuation often leads to relapse, and an episode of mania or depression in pregnancy carries its own risks to you and the baby. The NHS bipolar page says not to stop medicine unless told to by a doctor, and Tommy's says stopping can cause withdrawal symptoms, relapse or worsening symptoms.

If you have become pregnant unexpectedly, contact your psychiatrist or GP the same day. Decisions to switch or stop are best made in a planned way, often with a dose change rather than complete withdrawal.

Tommy's says lithium may increase the chance of heart defects in the baby, although the complications remain rare, while sodium valproate carries significant pregnancy risks and is covered by a Pregnancy Prevention Programme to avoid unplanned pregnancy. The NHS bipolar page confirms that some bipolar medicines are not safe in pregnancy.

Other options include certain antipsychotics and lamotrigine, each with its own balance of benefits and uncertainties, and the choice depends on your history and what has kept you well. The NHS medicines page and the BUMPS service are common references for individual medicines. A specialist perinatal psychiatrist, where available, is the best person to guide this.

• Ask for a pre-conception appointment with your psychiatrist or a perinatal mental health service.

• Ask which medicine gives the best balance for you, not only which has the least risk in isolation.

• If you take sodium valproate, discuss it urgently and use reliable contraception until a plan is agreed.

• Ask whether lithium needs blood-level monitoring more often in pregnancy, as levels can change.

Tommy's says everyone should take 400 micrograms of folic acid, and those on certain bipolar medicines may need a prescribed 5mg dose. Regular routines, adequate sleep, a healthy diet and exercise help stabilise mood, as the NHS notes, while alcohol, recreational drugs and irregular schedules can trigger episodes.

Sleep is a particularly important protective factor. Planning for how night-time feeds and care will be shared in the first weeks matters for mood, not just convenience.

Midwives ask about mental health at each antenatal appointment, as Tommy's notes. Tell them about the diagnosis early so that referral to a perinatal mental health team is arranged. These specialist services support women in pregnancy and for the first year after birth.

A written care plan agreed in pregnancy usually sets out early warning signs, who to call, which medicines to restart after birth, and who will look after you and the baby if you are unwell. Involving a partner, relative or friend who can recognise early changes is repeatedly recommended.

The weeks after birth are the highest-risk time. Tommy's reports that about a quarter of women with bipolar disorder develop postnatal depression and about a quarter develop postpartum psychosis, and that the risk rises to around 50% when there was a previous severe postpartum illness or such an illness in the family. These figures show why a plan is made in advance, not why pregnancy should be avoided.

Many plans involve restarting or increasing medicine soon after delivery, protecting sleep, and close follow-up in the first weeks. Postpartum psychosis is a medical emergency, with symptoms such as confusion, severe agitation, hallucinations or a sudden marked change in mood. Seek urgent help through NHS 111, A&E or 999, and see our separate guide.