Psychiatric and obstetric outcomes among peripartum patients with bipolar disorder: A single-institution study

Individuals living with bipolar disorder (BD) are at elevated risk for adverse obstetric and psychiatric outcomes in the peripartum period. This study aims to identify clinical correlates most associated with increased risk for poor psychiatric and pregnancy related outcomes.

This retrospective review examined electronic health records (EHR) from January 2017 to June 2023 for individuals with a history of BD and ≥1 pregnancy seen at our institution.55 individuals were included. Data on demographics, psychiatric, medical, and obstetric history were abstracted and analyzed for associations with outcomes of interest including mood episodes during pregnancy or first year postpartum, gestational diabetes and hypertension.

Pregravid obesity (BMI ≥ 30) was a risk factor for onset of a mood episode during pregnancy and postpartum. History of psychiatric hospitalization, comorbid anxiety disorder diagnosis, and any substance use during pregnancy were also associated with postpartum mood episodes. A history of self-harm, trauma, and pregravid obesity were associated with adverse obstetric outcomes (gestational diabetes mellitus and/or gestational hypertension). Among patients with BD, the specific diagnosis (type I, type II, or other specified bipolar disorder) was not significantly associated with psychiatric outcomes.

Our study is limited by omissions from the medical record, single-institution nature of the study, and small sample size.

This work is a step towards more individualized recommendations for perinatal patients with BD including the need to consider historical severity of illness as a predictor for mood episodes in pregnancy, noting that the specific BD subtype was not a predictor of mood course during pregnancy.