Question: What special precautions should pregnant or breastfeeding women keep in mind while taking bipolar medications?
Answer: This is an area that is under great research at the moment. I would advise, when possible, for anyone on bipolar medications to discuss with their psychiatrist prior to becoming pregnant what to do.
It used to be felt that lithium, for example, it caused a very high rate of heart defects. It appears more recently that that is not nearly so much of a worry. But before a woman becomes pregnant, it's useful to know what her thoughts are going to be about terminating the pregnancy if there are major defects. At the very least, following the pregnancy closely to make sure nothing happens is a good idea.
Certainly, we know that a depressed mother has negative effects upon a newborn child. A depressed mother may also have negative effects, or an agitated mother, upon the fetus itself. So it becomes a risk benefit titration between the benefits of the medication and the problems, or dangers, or risks it could potentially cause.
Certain medications used for bipolar disorder are dangerous and teratogenic -- that is -- potentially cause birth defects. So, again if a woman is contemplating pregnancy she may want to get off that medication and switch to another which has less risk.
In terms of breast feeding, certain medications are safer than others. In terms of breast feeding, at this point, again, it's useful to know what the latest research shows.
Additionally, you may want to watch the child to make sure that it isn't having an untoward response to the medications if the decision is made to medicate, to stay on medication, while breast feeding.