Background: Women with bipolar disorder (BD) are at high risk of mania/psychosis following childbirth. The risk factors for these episodes remain poorly understood and prospective studies are rare. Here, we examine whether mood episodes occurring within pregnancy predict postpartum recurrence in women with BD using a prospective design.

Method: 128 women with DSM-5 BD were followed from week 12 of pregnancy (baseline) to 12-weeks postpartum. Semi-structured interviews, supplemented by clinician questionnaires and case-note review, assessed lifetime psychiatric history at baseline, and perinatal psychopathology at two follow-up assessments: third-trimester of pregnancy and 12-weeks postpartum.

Results: Postpartum follow-up data were obtained for 124/128 (97%) women [98 bipolar I disorder/schizoaffective-BD (BD-I/SA-BD group) and 26 bipolar II disorder/other specified BD and related disorder (BD-II/BD-OS group)]. Perinatal recurrence was high in both diagnostic groups (57% and 62% respectively). Women with BD-I/SA-BD were significantly more likely to experience mania/psychosis within 6 weeks postpartum (23%, n=22/96) compared to those with BD-II/BD-NOS (4%, n=1/25; p=0.042). In BD-I/SA-BD, mania/psychosis in pregnancy significantly elevated risk of mania/psychosis postpartum compared to remaining well (RR 7.0, p<0.001) and experiencing non-psychotic depression in pregnancy (RR 3.18, p=0.023)

Limitations: Predominantly United Kingdom White sample and limited BD-II/BD-OS sample size.

Conclusions: Women with BD are at high risk of recurrence during pregnancy and the postpartum. Over and above risk conferred by a history of BD-I/SA-BD, mania/psychosis during pregnancy further increased risk of postpartum mania/psychosis in this high-risk group. These data may have important implications for prediction and management of severe postpartum recurrence of BD.

背景：患有双相情感障碍 (BD) 的女性在分娩后患躁狂症/精神病的风险很高。这些事件的风险因素仍然知之甚少，前瞻性研究也很少。在这里，我们使用前瞻性设计检查怀孕期间发生的情绪发作是否可以预测 BD 女性的产后复发。

方法：从妊娠第 12 周（基线）到产后 12 周，对 128 名 DSM-5 BD 女性进行了随访。半结构化访谈，辅以临床医生问卷和病例记录审查，评估基线时的终生​​精神病史，以及两次后续评估中的围产期精神病理学：妊娠晚期和产后 12 周。

结果：获得了 124/128 (97%) 名女性 [98 名双相 I 型障碍/分裂情感性 BD（BD-I/SA-BD 组）和 26 名双相 II 型障碍/其他特定 BD 和相关障碍的产后随访数据（ BD-II/BD-OS 组）]。两个诊断组的围产期复发率都很高（分别为 57% 和 62%）。与患有 BD-II/BD-NOS 的女性（4%，n = 1 /25；p = 0.042)。在 BD-I/SA-BD 中，与保持良好状态（RR 7.0，p <0.001）和妊娠期非精神病性抑郁症（RR 3.18，p=0.023)

局限性：主要是英国白人样本和有限的 BD-II/BD-OS 样本量。

结论：患有 BD 的女性在怀孕期间和产后复发的风险很高。除了 BD-I/SA-BD 病史带来的风险之外，妊娠期间的躁狂/精神病进一步增加了这一高危人群产后躁狂/精神病的风险。这些数据可能对 BD 严重产后复发的预测和管理具有重要意义。