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Factors that affect duration of untreated illness in pregnant women with bipolar disorder

Published:August 08, 2015DOI:https://doi.org/10.1016/j.ajog.2015.08.004
      To the Editors:
      We read with interest the paper by Mei-Dan et al
      • Mei-Dan E.
      • Ray J.G.
      • Vigod S.N.
      Perinatal outcomes among women with bipolar disorder: a population-based cohort study.
      who conducted a study about perinatal outcomes among women who are affected by bipolar disorder. The authors found that mothers with bipolar disorder have an increased risk of preterm birth and severe large-for-gestational-age babies. This latter finding may be due to treatment with atypical antipsychotics (eg, olanzapine), which are associated to higher risk of diabetes mellitus and increased weight of newborn infants.
      • Gentile S.
      Pregnancy exposure to second-generation antipsychotics and the risk of gestational diabetes.
      Unfortunately the authors did not consider pharmacologic treatment as a covariate of perinatal outcomes. In any case, the early diagnosis and proper treatment of patients with bipolar disorder are associated with better outcomes, including perinatal ones.
      • Altamura A.C.
      • Buoli M.
      • Caldiroli A.
      • et al.
      Misdiagnosis, duration of untreated illness (DUI) and outcome in bipolar patients with psychotic symptoms: a naturalistic study.
      In a sample of 26 pregnant patients with bipolar disorder, we investigated variables that were associated with longer duration of untreated illness (DUI), which is defined as the time between onset of symptoms and proper treatment (mood stabilizers or atypical antipsychotics).
      • Altamura A.C.
      • Buoli M.
      • Caldiroli A.
      • et al.
      Misdiagnosis, duration of untreated illness (DUI) and outcome in bipolar patients with psychotic symptoms: a naturalistic study.
      Longer DUI (>1 year) was found to be associated with family history of bipolar disorder (χ2 = 9.72; df = 6; P < .05; phi = 0.61). In contrast, a history of suicidal attempts was associated with a shorter DUI (≤1 year; χ2 = 5.31; df = 1; P < .05; phi = –0.45).
      Pregnant patients with relatives with bipolar disorder tend to seek psychiatric care later than patients with healthy/major depressed relatives. Probably major depressive episodes and suicidal attempts generate more concern in pregnant patients and their relatives with respect to hypomania. Suicidal attempts perhaps induce the patients to come into contact with psychiatric care through emergency services.

      References

        • Mei-Dan E.
        • Ray J.G.
        • Vigod S.N.
        Perinatal outcomes among women with bipolar disorder: a population-based cohort study.
        Am J Obstet Gynecol. 2015; 212: 367
        • Gentile S.
        Pregnancy exposure to second-generation antipsychotics and the risk of gestational diabetes.
        Expert Opin Drug Saf. 2014; 13: 1583-1590
        • Altamura A.C.
        • Buoli M.
        • Caldiroli A.
        • et al.
        Misdiagnosis, duration of untreated illness (DUI) and outcome in bipolar patients with psychotic symptoms: a naturalistic study.
        J Affect Disord. 2015; 182: 70-75

      Linked Article

      • Perinatal outcomes among women with bipolar disorder: a population-based cohort study
        American Journal of Obstetrics & GynecologyVol. 212Issue 3
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          To evaluate the risk of adverse perinatal outcomes among pregnant women previously hospitalized for bipolar disorder.
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        American Journal of Obstetrics & GynecologyVol. 213Issue 6
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          We thank Dr Serati et al for their letter to the editor about our paper.1 They posit that our observed higher risk of gestational diabetes mellitus and large-for-gestational birthweight might be due to atypical antipsychotic medication use in pregnancy. While not evaluated in the current study, we did an evaluation within another population-based study of 1021 antipsychotic-exposed pregnancies that were matched by high-dimensional propensity score to 1021 unexposed pregnancies.2 Therein, although antipsychotic users were at higher than general population risk for the aforementioned perinatal outcomes, there were no differences between antipsychotic users and matched control subjects.
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