We read with interest the paper by Mei-Dan et al who conducted a study about perinatal outcomes among women who are affected by bipolar disorder. The authors found that mothers with bipolar disorder have an increased risk of preterm birth and severe large-for-gestational-age babies. This latter finding may be due to treatment with atypical antipsychotics (eg, olanzapine), which are associated to higher risk of diabetes mellitus and increased weight of newborn infants.

Unfortunately the authors did not consider pharmacologic treatment as a covariate of perinatal outcomes. In any case, the early diagnosis and proper treatment of patients with bipolar disorder are associated with better outcomes, including perinatal ones.

In a sample of 26 pregnant patients with bipolar disorder, we investigated variables that were associated with longer duration of untreated illness (DUI), which is defined as the time between onset of symptoms and proper treatment (mood stabilizers or atypical antipsychotics). Longer DUI (>1 year) was found to be associated with family history of bipolar disorder (χ ² = 9.72; df = 6; P < .05; phi = 0.61). In contrast, a history of suicidal attempts was associated with a shorter DUI (≤1 year; χ ² = 5.31; df = 1; P < .05; phi = –0.45).

Pregnant patients with relatives with bipolar disorder tend to seek psychiatric care later than patients with healthy/major depressed relatives. Probably major depressive episodes and suicidal attempts generate more concern in pregnant patients and their relatives with respect to hypomania. Suicidal attempts perhaps induce the patients to come into contact with psychiatric care through emergency services.