One-year outcome after preconception consultation in women with bipolar disorder.

To the Editor: The pharmacologic management of bipolar disorder in women who wish to conceive poses a difficult dilemma for the patient, her partner, and the clinician.1 If psychotropic medication is discontinued, the patient is as likely to develop a recurrence during pregnancy as a nonpregnant woman,2,3 and immediately after childbirth she is more likely to become ill than remain well.3 However, continuation of several drugs used in bipolar disorder carries the risk of congenital or developmental anomalies in the offspring. This concerns foremost valproate,4 but also carbamazepine,5 lithium,6 and possibly lamotrigine.7 Psychiatrists specializing in perinatal disorders increasingly receive referrals for preconception consultation. Typically, the psychiatric and medication histories are carefully reviewed, and a medication plan is discussed with the patient and her partner and integrated into an overall relapse prevention plan. However, it is unknown what effect this intervention has on maternal mental health. In this uncontrolled retrospective evaluation, we examined maternal outcome in terms of treatment decisions made and symptoms experienced in the 12 months after preconception consultation in a specialist perinatal psychiatry service.