Abstract

IntroductionPatients with bipolar affective disorder can be effectively managed with pharmacological intervention. This case report describes a pregnant woman with a ten-year history of bipolar affective disorder that was being treated with lithium, haloperidol and benztropine.Case presentationThe patient had a normal pregnancy, but developed an elevated blood pressure and started to lose weight at 36 weeks of gestation. During pregnancy, plasma concentrations of choline and phosphatidylcholine are increased to meet the demands of the foetus. However, our findings in this case included depletion of plasma choline and phosphatidylcholine concentrations. Other unusual outcomes included low placental weight and low infant birth weight.ConclusionThis report suggests that the pharmacological management of this patient could possibly account for the findings.

Highlights

  • Patients with bipolar affective disorder can be effectively managed with pharmacological intervention

  • Patients with bipolar affective disorder are effectively managed with pharmacological intervention, such as lithium, haloperidol and benztropine, but studies on the influence of these drugs on plasma choline and phosphatidylcholine concentrations are limited

  • We found that in the case of our patient, there was an unusually low placental weight and a low infant birth weight when compared with data recorded from three control patients and from previous studies of our population [8]

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Summary

Introduction

Choline is a nutrient that is a precursor of phosphatidylcholine and the plasma concentrations of both nutrients are controlled by endogenous synthesis and dietary intake [1]. Patients with bipolar affective disorder are effectively managed with pharmacological intervention, such as lithium, haloperidol and benztropine, but studies on the influence of these drugs on plasma choline and phosphatidylcholine concentrations are limited. At 12 weeks gestation, the patient described her appetite as good, with two full meals and three snacks per day Her pregnancy booking BMI was 21.99 and plasma haemoglobin (Hb) was normal (11.4 mg/dL). In order to make further assessment of infant outcomes in this case, we selected other women from the larger study that were matched in gestation age, weight gain, blood pressure, haemoglobin status and infant gestational age at birth (Table 2). The most distinctive differences between these other women and this patient were the lower birth weight of the infant (30% less) and lower placental weight (42% less) We measured both fasting plasma phosphatidylcholine and choline through the three trimesters of pregnancy (Table 3). [1,15]

Conclusion
Findings
Zeisel SH
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