The management of bipolar disorder in the perinatal period and risk factors for postpartum relapse. Doyle et al. (2012) European Psychiatry 27, 563-569

For women with bipolar affective disorder (BPAD) the days after childbirth are a time of high risk for the onset of severe episodes of mental illness. Postpartum psychosis (PP) is usually very responsive to treatment, but delays in identification can result in longer, more severe episodes. In order to make childbirth a safer time for women with BPAD, the National Institute for Clinical Excellence (NICE) has recommended that pregnant women with BPAD should be referred to specialist perinatal mental health services, and a written care-plan formed.  To provide advice for such care-plans, it is important to know how an individual woman’s risk of postpartum bipolar relapse is affected by factors such as her clinical history, current mental state and previous response to medication.  This study identifies variables that affect this risk.

Case records of 78 women with BPAD referred to perinatal mental health services before conception, during pregnancy or the postpartum period were screened.  Of the women referred during pregnancy, 47% suffered postpartum relapse, while 53% remained well or only experienced mild symptoms.  Women who were unwell at referral, younger, with unplanned pregnancy, previous perinatal episodes or a family history of BPAD were more likely to experience postpartum illness.  However, duration of wellness before pregnancy did not affect likelihood of relapse.

The results indicate that women at risk need high quality care-plans, as well as close psychiatric monitoring, starting as soon as possible after delivery.  Women with BPAD, their GPs, midwives and psychiatrists should all be aware of the high risk of relapse following childbirth.  In particular, since the risk of relapse is considerable even for women who have remained well and medication-free for years before pregnancy, it is important that all women with BPAD receive referral to specialist mental health services in pregnancy.

**Summary awaiting verification from expert**