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Table 3 Characteristics of 9 included studies

From: Bipolar disorder in pregnancy and childbirth: a systematic review of outcomes

First author, year of publication EPHPP rating Aim of study Study design Diagnostic tool Sample Pharmaceutic treatment Length of follow-up Country
Akdeniz 2003 [68] M To evaluate and emphasise the impact of clinical and psychosocial risk factors associated with pregnancy and/or the postpartum period during the course of BD in women who had given birth Retro-spective cohort study BD (DSM-IV). Different types are not reported. 72 women with BD (252 pregnancies and 160 childbirths) Analysed a sub group: (n = 23): every mood episode that began during pregnancy and in postpartum period following birth at gestation 26 weeks+ Of women with post-partum episodes (n = 26) 21 had received psychotropic medication. None of the women with post-partum episodes took Lithium during pregnancy. Pregnancy, birth and up to one month post-partum Turkey
Bodén 2012 [69] S To investigate the risks of adverse pregnancy and birth outcomes for treated and untreated bipolar disorder during pregnancy. Retro-spective case control study BD (ICD-10 codes F30-31) A cohort of 332,137 women 2005–2009. Women with a record of at least two BD diagnoses (n = 874), 320 treated with mood stabiliser, 554 untreated, compared with all other women giving birth (n = 331,263) Treated BD with mood stabiliser (Lithium, antipsycotics or anticonvulsants) Pregnancy and birth Sweden
Di Florio 2013 [73] M To investigate the occurrence and timing of perinatal mood episodes in women with BD-I and BD-II Retro-spective cohort study BD-I and BD-II (DSM- IV) 1212 women (980 with BD-I (1404 births), 232 with BD-II (424 births) Pharmacotherapy not reported. Pregnancy, birth and up to one year postpartum United Kingdom
Di Florio 2014 [74] M To test the hypothesis that risk of perinatal mood episodes is greater after first pregnancy Retro-spective cohort study BD-I and BD-II (DSM-IV) 1212 women (934 with BD-I (1404 births), 278 with BD-II (424 births) No details on drug management reported. Pregnancy, birth and up to one year postpartum United Kingdom
Grof 2000 [75] M To examine statistically the clinical course of 28 women with typical bipolar disorder, type I, who became pregnant prior to receiving successful lithium prophylaxis Retro-spective case/control study BD (Re-search Diagnostic Criteria, (Spitzer et al. 1978)) 28 women with BD (56 pregnancies) and no Lithium prophylaxis; 33 childless women with BD (controls) None had prophy-lactic Lithium during pregnancy, but 4 took Lithium for depression towards end of pregnancy. Women with acute episodes received Lithium as treatment. Pregnancy, birth and up to 9 months postpartum A world-wide ethnic popul-ation (the majority from Canada).
Jablensky 2005 [67] M To determine the frequency, nature, and severity of 25 obstetric complic-ations in women with affective disorders and those with no psychiatric disorder Case control study BD (ICD-9 codes 296.0 and 296.2–5) 763 women with BD, 1,301 pregnancies; 1,831 women (3,129 pregnancies) with no history of mental health difficulties (controls) No specific information on prescription of medication available. Pregnancy and birth Australia
Lee 2010 [70] S To investigate pregnancy outcomes among women with bipolar disorder, compared with women with no history of mental illness, using nationwide population-based data Retro-spective case control study BD (ICD-9-CM codes 295.XX, 296.0X, 296.1X, 296.4X, 296.5X, 296.6X, 296.7X, 296.80 or 296.89) 337 women with BD; 528,061 women with no history of mental health difficulties (controls) Information on medical treatment not reported. Pregnancy and birth Taiwan
Mei-Dan 2015 [71] S To evaluate the risk of adverse perinatal outcomes among pregnant women previously hospitalised for BD Population based case control study BD (ICD-9, ICD-10CA, DSM-IV) 1859 women with BD; 3724 women with major depressive disorder (controls); 432,358 women with no mental illness (controls) No information regarding medical treatment. Pregnancy, birth and up to 27 days postpartum Canada (Ontario)
Munk-Olsen 2009 [72] S To compare mothers and nonmothers to assess whether childbirth increases the risk for psych-iatric readmission and to identify pre-dictors of psychiatric readmission during the first 12 months postpartum. Population cohort register study, prospec-tively studied BD (ICD-8 codes 296.19, 296.39 and 298.19. ICD-10 codes F30,F31, F34.0 and F38) All women born in Denmark between Jan 1, 1955 and July 1, 1990 who were alive on their 15th birthday and who had at least 1 psychiatric admission during the study period: January 1, 1973, through June 30, 2005. Analysis group 2 contained 56 women with bipolar disorder No data on pharmacological treatment available. Postpartum up to 12 months Denmark
  1. BD Bipolar Disorder, S Strong, M Moderate