Abstract
Background and rationaleAlthough it has been suggested that pregnancy may influence the course of bipolar disorder (BD), studies show contradictory results. Until now, no studies included a finegrained validated method to report mood symptoms on a daily basis, such as the lifechart method (LCM). The aim of the present study is to investigate the course of BD during pregnancy by comparing LCM scores of pregnant and non-pregnant women.MethodsStudy design: Comparison of LCM scores of two prospective observational BD cohort studies, a cohort of pregnant women (n = 34) and a cohort of non-pregnant women of childbearing age (n = 52). Main study parameters are: (1) proportions of symptomatic and non-symptomatic days; (2) symptom severity, frequency, and duration of episodes; (3) state sequences, longitudinal variation of symptom severity scores.ResultsNo differences in clinical course variables (symptomatic days, average severity scores, frequency, and duration of episodes in BD were found between pregnant and non-pregnant women. With a combination of State Sequence Analysis (SSA) and cluster analysis on the sequences of daily mood scores three comparable clusters were found in both samples: euthymic, moderately ill and severely ill. The distribution differences between pregnant and non-pregnant women were significant, with a majority of the pregnant women (68%) belonging to the moderately ill cluster and a majority of the non-pregnant women (46%) to the euthymic cluster. In pregnant women the average daily variation in mood symptoms as assessed with Shannon’s entropy was less than in non-pregnant women (respectively 0.43 versus 0.56).ConclusionsAlthough the use of daily mood scores revealed no difference in overall course of BD in pregnant versus non-pregnant women, more pregnant than non-pregnant women belonged to the moderately ill cluster, and during pregnancy the variation in mood state was less than in non-pregnant women. Further research is necessary to clarify these findings.
Highlights
Introduction and rationaleBipolar disorder (BD) is a recurrent mental illness characterized by depressive, hypomanic, and/or manic episodes separated by euthymic intervals and usually manifests in young adulthood (Goodwin and Jamison2007)
Women with bipolar disorder (BD) often ask their physician about the impact of pregnancy on the course of their illness
Unlike repeated findings that the postpartum period has a negative influence on the course of BD, with an overall risk of relapse of 35% (66% or medication-free women and 23% for women who used prophylactic medication) (Wesseloo et al 2016), the impact of pregnancy itself on the course BD is still uncertain, and various studies have reported conflicting results (McNeil et al 1984; Sharma and Persad 1995)
Summary
Introduction and rationaleBipolar disorder (BD) is a recurrent mental illness characterized by depressive, hypomanic, and/or manic episodes separated by euthymic intervals and usually manifests in young adulthood (Goodwin and Jamison2007). Patients with BD show considerable illness-related morbidity (Post et al 2003; Ferrari et al 2016) and the disorder significantly influences their wellbeing and social, occupational, and general functioning (Altshuler et al 2006; Bonnin et al 2012; Parker et al 2018). Women with BD often ask their physician about the impact of pregnancy on the course of their illness. It has been suggested that pregnancy may influence the course of bipolar disorder (BD), studies show contradictory results. The aim of the present study is to investi‐ gate the course of BD during pregnancy by comparing LCM scores of pregnant and non-pregnant women
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