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Women with bipolar disorder and pregnancy: factors influencing their decision-making

  • Clare Dolman (a1), Ian R. Jones (a2) and Louise M. Howard (a3)
Abstract
Background

Women with bipolar disorder are at increased risk of having a severe episode of illness associated with childbirth.

Aims

To explore the factors that influence the decision-making of women with bipolar disorder regarding pregnancy and childbirth.

Method

Qualitative study with a purposive sample of women with bipolar disorder considering pregnancy, or currently or previously pregnant, supplemented by data from an online forum. Data were analysed using thematic analysis.

Results

Twenty-one women with bipolar disorder from an NHS organisation were interviewed, and data were used from 50 women's comments via the online forum of the UK's national bipolar charity. The centrality of motherhood, social and economic contextual factors, stigma and fear were major themes. Within these themes, new findings included women considering an elective Caesarian section in an attempt to avoid the deleterious effects of a long labour and loss of sleep, or trying to avoid the risks of pregnancy altogether by means of adoption or surrogacy.

Conclusions

This study highlights the information needs of women with bipolar disorder, both pre-conception and when childbearing, and the need for improved training for all health professionals working with women with bipolar disorder of childbearing age to reduce stigmatising attitudes and increase knowledge of the evidence base on treatment in the perinatal period.

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Copyright
This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Corresponding author
Clare Dolman, Institute of Psychiatry, Psychology and Neuroscience, PO31 King's College London, De Crespigny Park, London SE5 8AF, UK. Email: clare.dolman@kcl.ac.uk
Footnotes
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Declaration of interest

None.

Footnotes
References
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1 Merikangas, KR, Akiskal, HS, Angst, J, Greenberg, PE, Hirschfeld, RM, Petukhova, M, et al. Lifetime and 12-month prevalence of bipolar spectrum disorder in the National Comorbidity Survey replication. Arch Gen Psychiatry 2007; 64: 543–52.
2 Di Florio, A, Forty, L, Gordon-Smith, K, Heron, J, Jones, L, Craddock, N, et al. Perinatal episodes across the mood disorder spectrum. JAMA Psychiatry 2013; 70: 168–75.
3 Wesseloo, R, Kamperman, AM, Munk-Olsen, T, Pop, VJ, Kushner, SA, Bergink, V. Risk of postpartum relapse in bipolar disorder and postpartum psychosis: a systematic review and meta-analysis. Am J Psychiatry 2016; 173: 117–27.
4 Jones, IR, Craddock, N. Familiality of the puerperal trigger in bipolar disorder: results of a family study. Am J Psychiatry 2001; 158: 913–7.
5 Bodén, R, Lundgren, M, Brandt, L, Reutfors, J, Andersen, M, Kieler, H. Risks of adverse pregnancy and birth outcomes in women treated or not treated with mood stabilisers for bipolar disorder: population based cohort study. BMJ. 2012; 345: e7085.
6 National Institute for Health and Care Excellence. Antenatal and Postnatal Mental Health: Clinical Management and Service Guidance (https://www.nice.org.uk/guidance/cg192). NICE, 2014.
7 Ennis, L, Wykes, T. Impact of patient involvement in mental health research: longitudinal study. Br J Psychiatry 2013; 203: 381–6.
8 Braun, V, Clarke, V. Using thematic analysis in psychology. Qual Res Psychol 2006; 3: 77101.
9 Flick, U. Triangulation in qualitative research. In A Companion to Qualitative Research (eds Flick, U, von Kardoff, E, Steinke, I): 178–83. Sage, 2004.
10 Megnin-Viggars, O, Symington, I, Howard, LM, Pilling, S. Experience of care for mental health problems in the antenatal or postnatal period for women in the UK: a systematic review and meta-synthesis of qualitative research. Arch Women's Ment Health 2015; 18: 745–59.
11 Allison, DB, Mentore, JL, Heo, M, Chandler, LP, Cappelleri, JC, Infante, MC, et al. Antipsychotic-induced weight gain: a comprehensive research synthesis. Am J Psychiatry 1999; 156: 1686–96.
12 McDonald, SD, Han, Z, Mulla, S, Beyene, J. Overweight and obesity in mothers and risk of preterm birth and low birth weight infants: systematic review and meta-analyses. BMJ. 2010; 341: c3428.
13 Medicines and Healthcare Products Regulatory Agency. Valproate and Risk of Abnormal Pregnancy Outcomes: New Communication Materials. Drug Safety Update 17 Feb 2016 (https://www.gov.uk/drug-safety-update/valproate-and-of-risk-of-abnormal-pregnancy-outcomes-new-communication-materials).
14 Dolman, C, Jones, I, Howard, LM. Pre-conception to parenting: a systematic review and meta-synthesis of the qualitative literature on motherhood for women with severe mental illness. Arch Women's Ment Health 2013; 16: 173–96.
15 Venkataraman, M, Ackerson, BJ. Parenting among mothers with bipolar disorder: strengths, challenges, and service needs. J Fam Soc Work 2008; 11: 389408.
16 Wilson, L, Crowe, M. Parenting with a diagnosis bipolar disorder. J Adv Nurs 2009; 65: 877–84.
17 Clement, S, Schauman, O, Graham, T, Maggioni, F, Evans-Lacko, S, Bezborodovs, N, et al. What is the impact of mental health-related stigma on help-seeking? Asystematic review of quantitative and qualitative studies. Psychol Med 2015; 45: 1127.
18 Jeffery, D, Clement, S, Corker, E, Howard, LM, Murray, J, Thornicroft, G. Discrimination in relation to parenthood reported by community psychiatric service users in the UK: a framework analysis. BMC Psychiatry 2013; 13: 120.
19 Lakshman, R, Ogilvie, D, Ong, KK. Mothers' experiences of bottle-feeding: a systematic review of qualitative and quantitative studies. Arch Dis Childhood 2009; 94: 596601.
20 Brett, J, Staniszewska, S, Mockford, C, Herron-Marx, S, Hughes, J, Tysall, C, et al. Mapping the impact of patient and public involvement on health and social care research: a systematic review. Health Expect 2014; 17: 637–50.
21 Engqvist, I, Ferszt, G, Åhlin, A, Nilsson, K. Women's experience of postpartum psychotic episodes – analyses of narratives from the internet. Arch Psychiatr Nurs 2011; 25: 376–87.
22 Ververs, T, Kaasenbrood, H, Visser, G, Schobben, F, de Jong-van den Berg, L, Egberts, T. Prevalence and patterns of antidepressant drug use during pregnancy. Eur J Clin Pharmacol 2006; 62: 863–70.
23 Einarson, A, Selby, P, Koren, G. Abrupt discontinuation of psychotropic drugs during pregnancy: fear of teratogenic risk and impact of counselling. J Psychiatry Neurosci 2001; 26: 44.
24 Khalifeh, H, Hunt, IM, Appleby, L, Howard, LM. Suicide in perinatal and non-perinatal women in contact with psychiatric services: 15 year findings from a UK national inquiry. Lancet Psychiatry 2016; 3: 233–42.
25 Walton, GD, Ross, LE, Stewart, DE, Grigoriadis, S, Dennis, C-L, Vigod, S. Decisional conflict among women considering antidepressant medication use in pregnancy. Arch Women's Ment Health 2014; 17: 493501.
26 Beydoun, H, Saftlas, AF. Physical and mental health outcomes of prenatal maternal stress in human and animal studies: a review of recent evidence. Paediatr Perinatal Epidemiol 2008; 22: 438–66.
27 Howard, L, Thornicroft, G, Salmon, M, Appleby, L. Predictors of parenting outcome in women with psychotic disorders discharged from mother and baby units. Acta Psychiatr Scand 2004; 110: 347–55.
28 Reupert, A, Maybery, D. Families affected by parental mental illness: a multi-perspective account of issues and interventions. Am J Orthopsychiatry 2007; 77: 362–9.
29 Mozingo, JN, Davis, MW, Droppleman, PG, Merideth, A. ‘It wasn't working’: women's experiences with short-term breastfeeding. MCN Am J Matern Child Nurs 2000; 25: 120–6.
30 Ross, CA, Goldner, EM. Stigma, negative attitudes and discrimination towards mental illness within the nursing profession: a review of the literature. J Psychiatr Ment Health Nurs 2009; 16: 558–67.
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Women with bipolar disorder and pregnancy: factors influencing their decision-making

  • Clare Dolman (a1), Ian R. Jones (a2) and Louise M. Howard (a3)
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