Bipolar disorder and planning a pregnancy

Most people who are living with bipolar disorder have a healthy pregnancy and baby. Your healthcare team will support you to stay well before, during and after pregnancy.

This information is for you if you are planning a pregnancy. If you are already pregnant with bipolar disorder there is helpful information for you here.

Why is it important to plan my pregnancy?

Most people with bipolar disorder have a healthy pregnancy and baby but there are some risks to be aware of. 

Some people with bipolar disorder can become unwell during their pregnancy, but the risks are higher after giving birth. 

• About 25% (25 in 100) of women with bipolar disorder develop postnatal depression.
• About 25% (25 in 100) of women with bipolar disorder develop postpartum psychosis.

The risk of postpartum psychosis is higher (50% or 50 in 100) if you have bipolar disorder if you also:

• have had a severe postpartum illness before
• have a mother or sister who have suffered a severe postpartum illness before.  

Some medicines used to treat bipolar disorder may carry risks in pregnancy.  It is important to talk to your doctor, so you can understand  the risks and benefits of all your treatment options. 

You can read more about severe mental illness and medication in pregnancy here. 

Do not stop taking your medicine before talking to a doctor. 

This can:

• lead to withdrawal symptoms
• make your symptoms come back
• make your symptoms get worse. 

This can be difficult to read but your healthcare professional can support you.

Planning for pregnancy (before you stop taking contraception) with your healthcare team will help you feel confident that:

• you are on the best medication for you and your baby
• your condition is as stable as possible
• you understand your ‘early warning signs’ of becoming unwell so that you, and those close to you, can watch out for them.

Because it’s impossible to know when you will become pregnant it is important to keep using contraception until you’ve spoken to your doctor about your treatment.

Sometimes pregnancies are not planned. If you are already pregnant, talk  to your midwife  or healthcare team about your condition straight away. Do not stop taking medication without talking to them. 

Find out more about bipolar disorder during pregnancy.

Who will support me with getting pregnant with bipolar disorder? 

Talk to your GP and psychiatric team and ask to be referred to a perinatal mental health team. These are mental health professionals with a special interest in pregnancy and childbirth.

If there is no local service, it may be possible to see a perinatal psychiatrist further away or there may be a specialist Mood Disorder Service in your area. 

If these options are not available, you should see a psychiatrist for advice , even if you are not under the care of psychiatric services right now. Ask your doctor about getting a referral.  

You will be able to discuss: 

• how to make sure you are as well as possible when starting pregnancy
• your risk of developing postpartum psychosis or postnatal depression
• risks and benefits of medication in pregnancy and after birth 
• the type of care you can expect in your local area. 

Medication for bipolar disorder and planning a pregnancy

Some medicines used to treat bipolar disorder carry risks for the baby.

Lithium may increase the risk of heart defects and other congenital abnormalities in the baby,   though these complications are rare.  

Some people will need these medications during pregnancy to stay well. In these circumstances, you may be advised to:

• stay on your current treatment throughout conception, pregnancy, and birth
• switch to another treatment
• stop or reduce the dose of your medication.

Your healthcare professional should explain the risks and benefits of all your options clearly so you can make an informed decision about your care.

Folic acid

Everyone is recommended to take a 400 mcg folic acid supplement before they get pregnant. Ideally, you should take folic acid for 3 months before getting pregnant. 

You may be advised to take a higher dose (usually 5 mg) if you are taking some medications for your condition. This is only available on prescription.

Your doctor can give you more advice about folic acid. 

Sodium valproate

If you are taking sodium valproate the risks to pregnancy and your baby's development are high. But for a small number of people, this is the only treatment that works and stopping it may lead to a serious relapse. 

If you are prescribed sodium valproate you should also be enrolled in a Pregnancy Prevention Programme (PPP). The programme helps you avoid an unplanned pregnancy by giving you advice on the most effective contraception to avoid the risks of taking sodium valproate in pregnancy. 

If you or your partner are taking sodium valproate but want to try for a baby, speak with your doctor. Experts will be able to support you in making a decision about treatment options that feels right for you. They can advise on the impact of sodium valproate on male fertility, and the risks of unprotected sex while taking the medicine. 

Care plan during pregnancy

Your mental health specialist and midwife will work together with you to make a care plan for how your condition will be treated during pregnancy, birth and afterwards. 

This plan should include how you will be treated if you decide to breastfeed and how you will be monitored for relapse after you have the baby. 

You should be given a copy of the plan and there should be details of how you and your family can get help quickly if you become unwell. It’s a good idea to share this plan with anyone involved in your pregnancy care.

Psychological therapy

Your specialist may offer cognitive behavioural therapy. This may be helpful if you change your medication. 

How can I help myself?

Planning to have a baby is very exciting, but it can also be very daunting. You’ve probably got a lot on your mind, such as money, work and how long it will take to get pregnant. 

It’s natural to feel a bit anxious about these things, but it’s important to try and keep stress to a minimum. 

Taking some time to think about and make plans for how you will cope with pregnancy and a baby can help.

Support from family and friends

Having support from family and friends before during and after pregnancy is important, especially if you have a mental health condition. 

Talk to the people closest to you about how you feel and any concerns you have about pregnancy, being a parent, your illness and how it can affect you. If they understand more about how you’re feeling they can give better support. 

For example, they could:

• help you with jobs around the house if you’re feeling sick or tired in pregnancy
• do your shopping so you can get some sleep
• go for walks or listen to music with you to help you relax
• reassure you if you’re feeling anxious
• recognise any signs or symptoms that you’re becoming unwell and help you get the professional care you need.

Professional support 

Try to be honest about how you’re feeling with the professionals who are looking after you while you try to get pregnant. Make sure you know what type of care you should be getting and who you can contact in an emergency. It can help if the people closest to you have this information too. 

You can also find more information and support from charities such as Bipolar UK and Bipolar Fellowship Scotland.

Taking care of yourself

Here are some simple ways to take care of yourself while trying for a baby.

• Keep a mood diary so you learn to recognise signs your mood is changing. This is an example mood diary from Bipolar UK or you could try an app such as Emoodtracker.
• Use stress management strategies, such as avoiding stressful situations where possible or using cognitive behavioural therapy techniques to cope with unavoidable stress
• Practise relaxation exercises
• Don’t take on too much and make time for yourself
• Take your medication, even if you’re feeling fine. 
• Talk to your doctor about your pregnancy plans before changing or stopping medication.

Find out more about looking after your general mental health and wellbeing while you’re trying for a baby. 

More information and support

Here are 5 things to think about when you’re planning to get pregnant while managing a serious mental illness.

You can get more support from the following organisations:

Bipolar UK

Bipolar Fellowship Scotland

MIND

Action on Postpartum Psychosis