Phagocytosis and erythroblastosis

Managing bipolar disorder during pregnancy: weighing the risks and benefits

BACKGROUND

Challenges for the clinical management of bipolar disorder (BD) during pregnancy are multiple and complex and include competing risks to mother and offspring.

METHOD

We reviewed recent research findings on the course of BD during pregnancy and postpartum, as well as reproductive safety data on the major mood stabilizers.

RESULTS

Pregnancy, and especially the postpartum period, are associated with a high risk for recurrence of BD. This risk appears to be limited by mood-stabilizing treatments and markedly increased by the abrupt discontinuation of such treatments. However, drugs used to treat or protect against recurrences of BD vary markedly in teratogenic potential: there are low risks with typical neuroleptics, moderate risks with lithium, higher risks with older anticonvulsants such as valproic acid and carbamazepine, and virtually unknown risks with other newer-generation anticonvulsants and atypical antipsychotics (ATPs).

CONCLUSIONS

Clinical management of BD through pregnancy and postpartum calls for balanced assessments of maternal and fetal risks and benefits.

Effect of betamethasone on fetal macrophage function: depression of adherence of immunoglobulin-coated red blood cells

In this study, betamethasone was found to significantly inhibit the binding of immunoglobulin-coated O Rh-positive red cells to fetal macrophages. At a dose of 0.15 mg%, betamethasone depressed immune rosette formation to 44% of controls (p less than 0.01); and a dose of 0.60 mg% resulted in an average depression to 22%. This in vitro effect may reflect important alterations in in vivo immune function in infants delivered from mothers who have received antenatal corticosteroids.