Thursday, February 22, 2007

The Decision to Get Pregnant

There are two issues I have been grappling with in deciding to start a family. So today I'll tackle the first one -- should someone who is bipolar have kids.

This is a very complicated and personal decision and also one that lots of people like to weigh in on. Countless people in depression and bipolar support groups and on various message boards have said they can't ever imagine bringing a child into the world who may inherit a mental illness. And for a while I too thought the same thing. But over the last few years as my illness stabilized my opinion changed.

So here are my answers to the questions my people have asked:

1. Aren't you worried that your child will be bipolar?
I'm really not that concerned for several reasons. Although bipolar disorder does have a strong genetic risk -- according to many doctors and scientists the risk of passing the disease is 10%. Some geneticists say it may be as high as 15%. Many people with the disorder exaggerate the number and are concerned that it is around 50%. It isn't

To put it in perspective - The risk really isn't that large. Currently 31% of Americans are obese. So statistically speaking my child will have a more than three times the of risk of developing obesity. Obesity greatly increases the risk of other serious medical conditions including diabetes which is the 6th leading cause of death in this country. Obesity also increases the risk of cancer, heart attacks and strokes.

I beleive in 15 years the advances of science will make living with bipolar a non-issue. Doctors and scientists are greatly expanding their understanding of how the brain works and how it misfunctions.

Only 13 years ago there was one medication approved for bipolar (lithum). Just 10 year ago there were only two medications (lithium and depakote). Now there are more choices and better treatments. Currently the following are approved for different phases of bipolar: Lithium, Depakote, Lamictal, Symbyax, Seroquel, Risperdal, Geodon, Abilify and Equetro (extended release version of Tegretol). And many more drugs are used "off-label." If so much has changed in the last 15 years, what do you think will happen in the next?

Aren't you concerned you will get depressed or manic while pregnant?
I realize that going off meds is a risk. However, I have full faith that if something happens my doctor will be able to get me back on track. I believe that eating right, exercising, maintatining a regular sleep schedule and keeping stress levels in check will affect my ability to stay well. I also don't intend to stay off my meds for the entire pregnancy.

Aren't you worried that the medication could be bad for a developing fetus?
I've read the studies, poured over the data from the pregnancy registries and I think that my medication (Lamictal) is actually fairly safe. So far the statisics show a 2.9% incidence of major birth defects. The baseline rate for the general population is 3%. Which means that if the data is correct -- you do not have a greater chance of birth defects than someone who is not on meds. I've also decided to go back on medicine the second trimester. Although at a lower dose than I was on before.
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