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Table 6 Fetal and neonatal complications in babies of 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
Low birthweight
 Jablensky 2005 [67] Defined as < percentage estimated birth weight < 10th percentile. Women with BD were NOT more likely to have LBW infants (9.9 % vs.9.3 %) than pregnant women with no history of mental health difficulties.
This cohort included only 55 % of women with pre-existing BD, who 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).
None None
 Lee 2010 [70] Women with BD were more likely to have low birth weight infants (9.8 % vs.5.7 %) than pregnant women with no history of mental health difficulties (AOR 1.66 (95 % CI 1.16–2.38)). Smoking could be a large part of the causation Monitoring of fetus, early intervention if abnormalities are noted.
SGA
 Bodén 2012 [69] No significant results for SGA were reported for women with BD (neither for the group treated with mood stabilisers nor for those not treated). None None
 Jablensky 2005 [67] No difference found in SGA in women with BD compared with those with no mental health difficulties. None None
 Lee 2010 [70] Women with BD were more likely to have SGA (22.3 % vs.15.7 %) than pregnant women with no history of mental health difficulties (AOR 1.47 (95 % CI 1.14–1.91)). Smoking could be a large part of the causation Monitoring of fetus, early intervention if required.
 Mei-Dan 2015 [71] Severe SGA (<3rd percentile), was not significantly elevated in BD (n = 84, 4.6 %; AOR 1.15 (95 % CI 1.05–1.42) compared with the referent group (n = 16.823, 3.9 %). SGA (<10th percentile): BD presented increased risk compared to reference group: BD: n = 258 of 1859 14.1 %, reference group n = 54 858 12.8 %. AOR 1.17 (95%CI 1.03–1.34).
Adjusted for: maternal age, income quintile, hypertension, venous thromboembolic disease, gestational diabetes, gestational hypertension, pre-eclampsia/eclampsia
None Interventions should be evaluated, to optimise health of women with BD
LGA
 Mei-Dan 2015 [71] Severe LGA (>97th percentile) was significantly more common among women with BD (n = 69, 3.8 %; AOR 1.29. 95 % CI 1.08–1.54). Reference group 2.7 %, n = 11 712.
Adjusted for: maternal age, income quintile, hypertension, venous thromboembolic disease, and gestational diabetes, gestational hypertension, pre-eclampsia/eclampsia
LGA (>90th percentile) was NOT significantly more common. BD 167 of 1859 9.1 % compared to referent without mental illness n = 35,158 8.2 %. AOR 1.13 (0.96.1.32).
None Interventions should be evaluated, to optimize health of women with BD
Congenital anomalies
 Bodén 2012 [69] Congenital malformations in infants born to women: without BD: 2.0 %; with BD without treatment with mood stabilisers: 1.9 %; with BD with treatment with mood stabilisers: 0 to 3.5 %, depending on the drug used, average 3.4 % (Numbers calculated by this review team). None None
 Jablensky 2005 [67] No difference found in congenital abnormalities in women with BD compared with those with no mental health difficulties. None None
 Mei-Dan 2015 [71] BD did present increased risk for congenital anomalies. BD n = 90, 0.5 %. Referent group n = 14 963, 3.5 %. AOR: 1.48 (95 % CI 1.20–1.82) Adjusted for: maternal age, income quintile, hypertension, venous thromboembolic disease, gestational diabetes, gestational hypertension, pre-eclampsia/eclampsia None None
Neonatal re-admissions
 Mei-Dan 2015 [71] Neonatal admission, < 28 days of life. BD did have increased risk. N = 36, 2.0 % compared to referent n = 3953, 0.9 %. AOR: 2.41 (95 % CI 1.76–3.31) Adjusted for: maternal age, income quintile, hypertension, venous thromboembolic disease, and gestational diabetes, gestational hypertension, pre-eclampsia/eclampsia None None
Fetal distress
 Jablensky 2005 [67] No difference in fetal distress, cephalopelvic disproportion, atypical presentation, or cord anomalies, threatened preterm labor, early rupture of the membranes, prolonged labour, low 5-min Apgar scores, neonatal mortality in women with BD compared with those with no mental health difficulties. None None
 Boden 2012 [69] Showed no difference in low Apgar scores between women without BD and those untreated (AOR 1.56, 95 % CI = 0.85–2.86) and treated (AOR 0.88, 95 % CI = 0.33–2.34) for BD. None None
Stillbirth
 Jablensky 2005 [67] No difference found in stillbirths in women with BD compared with those with no mental health difficulties. None None
 Mei-Dan 2015 [71] BD did not present increased risk for stillbirth. BD n = 11, 0.6 %. Referent group n = 2235, 0.5 %. AOR 1.20 (95 5 CI 0.66–2.18), adjusted for: maternal age, income quintile, hypertension, gestational diabetes, gestational hypertension, venous thromboembolic disease, preeclampsia None None
Infant mortality
 Mei-Dan 2015 [71] Infant mortality < 28 days of life. BD did not have increased or reduced risk N = ≤ 5, referent group n = 1004, 0.2 %. AOR: 0.72 (0.23–2.23). Mortality <1 year of life. No difference in risk BD n = 7, 0.4 % referent group n = 1389, 0.3 %. AOR: 0.99 (95 % CI 0.44–2.22) None None
Neonatal morbidity
 Mei-Dan 2015 [71] Secondary outcome; neonatal morbidity defined as RDS (respiratory distress syndrome), Seizure, sepsis, IVH (Intravenous hyperalimentation), persistent fetal circulation, and neonatal abstinence syndrome.
1. Any of these neonatal morbidities: BD had increased risk: n = 96, 5.4 %. Referent group (without mental illness) n = 8270, 1.9 %. AOR 2.99 (95 % CI 2.44–3.66)
2. RDS: BD had increased risk. N = 26, 1.5 %. Referent group: n = 4049, 1.0 %. AOR 1.64 (95 % CI 1.13–2.39)
3. Seizure: BD had increased risk. BD n = 10. 0.6 %, referent group n = 844, 0.2 %. AOR = 2.54 (95%CI 1.31–4.90).
4. Sepsis: BD had increased risk. BD n = 23, 1.3 %, referent group 3178, 0.7 %. AOR: 1.80 (95 % CI 1.20–2.70)
5. IVH: BD had increased risk. BD n = 13, 0.7 %. Referent group n = 1485, 0.3 %. AOR: 2.12 (95 % CI 1.22–3.67).
6. Persistent fetal circulation. BD did NOT have increased risk. BD n = ≤ 5, referent group n = 615, 0.1 %. AOR: 1.89 (95 % CI 0.78–4.58).
7. Neonatal abstinent syndrome. BD had severe increased risk. BD n = 70, 1.9 %. Referent group n = 177, 0.0 %. AOR = 52.2 (95 % CI 36.5–74.7)Adjusted for: maternal age, income quintile, hypertension, venous thromboembolic disease, gestational diabetes, gestational hypertension, pre-eclampsia/eclampsia
None None
  1. BD Bipolar Disorder, CI Confidence Interval, SGA Small for Gestational Age, LGA Large for Gestational Age, AOR Adjusted Odds Ratio, OR Odds Ratio