Bipolar illness, lithium prophylaxis, and pregnancy

In advising bipolar patients wishing to become pregnant, Weinstein's guidelines were extended to seven stages: contraceptive measures; genetic counseling; discontinuing lithium in the first trimester or prescribing alternatives; ultrasound scanning for congenital anomalies, low lithium levels during pregnancy; discontinuing lithium at the end of pregnancy; starting immediately after birth, no breast feeding, observation of the neonate in the neonatal ward; and close observation of the patient in the follow-up year. Of the 15 bipolar patients, 11 gave birth to healthy children (five of them twice). Most patients knew nothing about the inheritance of bipolar illness. Four made no further attempt to become pregnant: two in view of a serious possibility of inheritance, the other two after a severe relapse. Three patients chose an alternative to lithium medication (carbamazepine and haloperidol). Postpartum, 27% of the patients who used medication relapsed and 60% of the patients who used none relapsed.