Managing Bipolar Disorder in Childbearing Women
Target Audience: Pharmacist, Physician Assistant, Physician
Course Overview
Bipolar disorder is a common and serious psychiatric condition with disabling consequences. Women have the highest risk of being diagnosed with bipolar or having a recurring episode during pregnancy or within one year of giving birth. Sleep deprivation in postpartum women can lead to worsening of the patient's bipolar disorder. In pregnant and postpartum women who are diagnosed with bipolar disorder, lithium is considered the gold standard for the treatment of bipolar disorder. Lithium can be used as an effective treatment to control symptoms. However, fluctuations in serum lithium levels can lead to subtherapeutic levels during the first and second trimesters and supratherapeutic or even toxic levels in the third trimester and postpartum period. In addition, lithium use during pregnancy carries risks. The American College of Obstetricians and Gynecologists issued new guidelines for lithium use during pregnancy and postpartum to address these risks. In cases where lithium is not preferred, other medications may be appropriate. For example, lamotrigine, an anticonvulsant, is widely considered non-teratogenic and is often used as a safe alternative to lithium in pregnancy.
Learning Objectives
Upon completion of this educational activity, participants should be able to:
- Assess bipolar disorder in women during the peripartum period
- Describe the potential risks of lithium use during pregnancy
- Describe the fluctuations in serum lithium levels during pregnancy and the postpartum period, leading to subtherapeutic or supratherapeutic lithium levels
- Review the guidelines for lithium use during pregnancy and postpartum
- Describe the lithium laboratory test monitoring in pregnant and postpartum women who are prescribed lithium
- Review alternative psychotropic therapies for bipolar disorder in pregnant and postpartum women
Faculty
- Introduction
- Bipolar Disorder in Pregnant Women
- Screening for Bipolar Disorder
- Lithium as a Treatment for Bipolar Disorder in Childbearing Women
- Discussing the Risks and Benefits of Lithium Use During Pregnancy
- Discontinuing the Use of Lithium
- Teratogenic Risks
- Risk of Spontaneous Preterm Birth
- Risk of Miscarriage
- Managing Lithium's Teratogenic, Miscarriage, and Suicide Risks
- Managing Teratogenic Risks
- Managing the Risk of Miscarriage
- Managing Suicide Risks
- Lithium Pharmacokinetics in the Perinatal Period
- Subtherapeutic Levels
- Supratherapeutic or Toxic Levels
- Lithium and Muscle Relaxants
- Laboratory Testing and Monitoring
- Lithium Dosing Adjustments During Pregnancy
- Lithium Adverse Events and Poisoning
- Lithium and Breastfeeding
- The American College of Obstetricians and Gynecologists (ACOG) Guidelines
- Alternative Drugs During Pregnancy
- Treating Sleep Deprivation
- Lithium Use During Pregnancy: Case Reports
- Case Report I
- Case Report II
- Case Report III
- Key Points
- Summary
From May 1, 2026 through May 1, 2029, participants must:
- Read the "learning objectives" and "author and planning team disclosures"
- Study the section entitled "educational activity"
- Complete the Course Test and Evaluation form. The Course Test will be graded automatically. Following successful completion of the Course Test with a score of 70% or higher, a statement of participation will be made available immediately. (No partial credit will be given.)
Credit for this course will be automatically uploaded to CPE Monitor®.
Faculty Planner Disclosure
The following individuals were involved in planning, developing, and/or authoring this activity: L. Austin Fredrickson, MD, FACP; Douglas Evans, APRN, PMHNP-BC; Anna S. Smith, MPH, BSN-RN; and Pamela Sardo, PharmD, BS. None of the individuals involved in developing this activity has a conflict of interest or financial relationships related to the subject matter. There are no financial relationships or commercial or financial support relevant to this activity to report or disclose by RxCe.com or any of the individuals involved in the development of this activity.
Unlabeled Use Disclosure
The information provided in this course is general in nature, and it is designed solely to provide participants with continuing education credit(s). This course and materials are not meant to substitute for the independent, professional judgment of any participant regarding that participant's professional practice, including but not limited to patient assessment, diagnosis, treatment, and/or health management. Medical and pharmacy practices, rules, and laws vary from state to state, and this course does not cover the laws of each state; therefore, participants must consult the laws of their state as they relate to their professional practice. Healthcare professionals must consult their employer, healthcare facility, hospital, or other organization for guidelines, protocols, and procedures to follow. The information provided in this course does not replace those guidelines, protocols, and procedures, but is for academic purposes only, and this course's limited purpose is for the completion of continuing education credits. Participants are advised and acknowledge that information related to medications, their administration, dosing, contraindications, adverse reactions, interactions, warnings, precautions, or accepted uses is constantly changing. Any person taking this course understands that such a person must make an independent review of medication information before any patient assessment, diagnosis, treatment and/or health management. Any discussion of off-label use of any medication, device, or procedure is informational only, and such uses are not endorsed hereby. Nothing contained in this course represents the opinions, views, judgments, or conclusions of RxCe.com LLC. RxCe.com LLC is not liable or responsible to any person for any inaccuracy, error, or omission with respect to this course or course material.
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Accreditation
In support of improving patient care, RxCE.com is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.