The postpartum period and bipolar disorder: early identification, prevention, and management

INTRODUCTION: New-onset or worsening bipolar disorder is common after childbirth and is associated with increased risk of psychiatric hospitalization, along with safety concerns for the mother and newborn. Despite the availability of several medications, preventing postpartum bipolar mood episodes remains difficult. AREAS COVERED: This narrative review outlines findings of a search of MEDLINE/PubMed, PsycINFO, and the Cochrane Database of Systematic Reviews in November 2025. The author examines the challenges of preventing postpartum mood episodes in women with bipolar disorder and discusses opportunities for early detection and treatment of symptoms during and after pregnancy. Continuation of optimized maintenance treatment to mitigate the risk of recurrence associated with weaning and resumption of menstruation is emphasized. This review also highlights research gaps, particularly the lack of treatment studies. EXPERT OPINION: Efforts to prevent postpartum episodes of bipolar disorder should include timely identification of at-risk individuals, confirming diagnosis and psychiatric comorbidities, reviewing illness course, and analyzing risk and protective factors, psychoeducation, mitigating risk factors, vigilant monitoring for emerging symptoms of relapse or recurrence, tailoring treatment, assessing breastfeeding safety and compatibility, and addressing safety concerns. Follow-up should continue for several months, as mothers remain at risk of relapse during weaning, resumption of menstruation, and the return to work after maternity leave.