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Table 5 Obstetric complications in women with bipolar disorder

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

First author, year of publication Key findings: reported by authors Potential mechanisms suggested by authors Key recommendations made by authors
Obstetric complic-ations
 Jablensky 2005 [67] Women with pre-existing BD had a significantly increased risk of obstetric complications (OR 1.13, 95 % CI = 1.02–1.25), whereas those who developed BD after the index birth were at no more risk than the women without mental health difficulties (OR 1.02, 95 % CI = 0.92–1.12) (Chi-square =157.56, df = 8, p < 0.0001).   
Antepartum hemorrhage
 Jablensky 2005 [67] Women with BD were more likely to have antepartum haemorrhage than pregnant women with no history of mental health difficulties (adjusted OR 1.60 (95 % CI 1.11–2.32)). Possibly due more to clustering of adverse maternal characteristics than to any one factor Research required into environmental and genetic reproductive risks
Placenta praevia
 Jablensky 2005 [67] Women with BD were more likely to have placenta praevia than pregnant women with no history of mental health difficulties (adjusted OR 2.13 (95 % CI 1.15–3.94)).
Women with pre-existing BD had a significantly increased risk of obstetric complications (OR 1.13, 95 % CI = 1.02–1.25), whereas those who developed BD after the index birth were at no more risk than the women without mental health difficulties (OR 1.02, 95 % CI = 0.92–1.12) (Chi-square =157.56, df = 8, p < 0.0001).
Possibly due more to clustering of adverse maternal characteristics than to any one factor Research required into environmental and genetic reproductive risks.
Gestational hypertension
 Lee 2010 [70] Women with BD were more likely to have gestational hypertension (1.5 % vs. 0.5 %) than pregnant women with no history of mental health difficulties (p < 0.02). None None
Gestational diabetes
 Lee 2010 [70] No difference in rates of gestational diabetes between women with and without BD. None None
 Bodén 2012 [69] No increased risk for gestational diabetes in either treated or untreated women with BD compared to women without BD.   
Induction/elective CS
 Bodén 2012 [69] Instrumental birth: Women without BD 24.7 %; BD without treatment 33.0 %, AOR 1.49 (95 % CI 1.24 to 1.81); BD with treatment 34.1 %, AOR 1.39 (95 % CI 1.09 to 1.79)
Caesarean birth: Women without BD 16.8 %; BD without treatment 23.5 %, AOR 1.45 (95 % CI 1.18 to 1.78); BD with treatment 25.6 %, AOR 1.56 (95 % CI 1.20 to 2.03)
Non-spontaneous start of labour: Women without BD 20.7 %; BD without treatment 30.9 %, AOR 1.57 (95 % CI 1.30 to 1.90); BD with treatment 37.5 %, AOR 2.12 (95 % CI 1.68 to 2.67)
Mood stabilising treatment is not necessarily the sole reason for increased risk of adverse outcomes. Important to balance risks between treating and not treating BD.
Preterm birth
 Bodén 2012 [69] The risk of preterm birth (before 37 weeks gestation) was increased for women with BD, both for the treated and the untreated, compared with women without BD. Women without BD 4.8 %; BD without treatment 7.6 %, AOR 1.48 (95 % CI 1.08 to 2.03); BD with treatment 8.1 %, AOR 1.50 (95 % CI 1.01 to 2.24). None None
 Lee 2010 [70] Women with BD were more likely to have preterm births (14.2 % vs 6.9 %) than pregnant women with no history of mental health difficulties (AOR 2.08 (95 % CI 1.53–2.83). Smoking could be a large part of the causation  
 Mei-Dan 2015 [71] Preterm birth was defined as < 37 gestational weeks. Higher prevalence for BD women 11.4 %, 212 out of 1858) and the BD group together with the ‘major depressive disorder’ group with preterm birth (11.4 %, N = 405) did, together, show increased prevalence above the referent group (6.2 %, n = 27000). Crude OR for BD: 1.93 (95 % CI 1.67–2.23. Adjusted OR for BD: 1.95 (1.68–2.26) when the control group was the referent (=1.00), adjusted for: maternal age, income quintile, hypertension, venous thromboembolic disease, gestational diabetes mellitus, gestational hypertension, preeclampsia/eclampsia. Preterm birth defined as < 32 gestational weeks. BD did have increased risk. N = 34, 9.1 %. Referent group n = 4884, 1.1 %. AOR: 1.70 (95 % CI 1.16–2.48). Preterm birth defined as < 28 gestational weeks. No significant increased risk. None None
  1. BD Bipolar Disorder, CI Confidence Interval, AOR Adjusted Odds Ratio, OR Odds Ratio