Trastorno bipolar en embarazo y lactancia

Abstract

Bipolar disorder (BD) is a psychiatric chronic disease, characterized by mood fluctuations, from mania to bipolar depression. Given that it usually debuts in young adults, it affects women in childbearing age and pregnant women. BD is associated with a higher risk of adverse outcomes during pregnancy, including those related to medication and possible relapses. The objective of this systematic review is to analyse recent and high-quality bibliography about the pharmacologic treatment of BD, by the means of a systematic research in PubMed, collecting articles published between 2012 and 2017, and selecting those with the highest quality according to the standards of the PRISMA guideline. Psychotropic medication used in BD, which is mainly lithium, some antiepileptic drugs, antipsychotics, antidepressants and benzodiazepines, has been associated with adverse outcomes such us congenital malformations, cardiac anomalies, neurodevelopmental problems, neonatal adaptation syndrome, spontaneous abortion and preterm delivery, among others. Recommendations provided by Clinical Practices Guidelines (CPG) must be interpreted with caution, given that they are based on variable levels of evidence, and most part of the available data needs to be further investigated in future studies. In conclusion, regarding the management of BD during pregnancy and breastfeeding, we must choose the drug with the best security profile, using the minimum effective dose, in monotherapy if possible, and it is mandatory to monitor closely the evolution of the woman and her child. CPG provide an adequate and necessary support, but treatment must be individualized.