Awareness of teratogenic risks of mood stabilizers and associated factors among women of reproductive age women with bipolar disorder and practitioners’ counseling practice at jimma medical center, Ethiopia: a mixed study design

Abstract

Background: Teratogenic exposure during pregnancy poses a significant risk to fetal development, increasing the overall risk of major congenital malformations. Despite the serious implications of teratogenic exposure due to the use of mood stabilizers, limited studies have been conducted to assess the awareness of among women of reproductive age regarding these risks. This study aims to assess the awareness of mood stabilizer teratogenic risks and the factors affecting it in women of reproductive age with bipolar disorder attending follow-up treatment at Jimma Medical Center, Ethiopia. Objective: To assess awareness of mood stabilizer teratogenic risk and associated factors among women of reproductive age with bipolar disorder attending follow-up treatment and counseling practice of mental health practitioners at Jimma Medical Center, Southwest Ethiopia, 2025. Methods: A mixed methods study with an embedded design was conducted from January to March 2025. A total of 170 women were selected for the quantitative study using a consecutive sampling technique. Data was collected through face-to-face interviews using structured and semi structured questionnaire. The collected data using kobo tool box was exported to Statistical Package for Social Science (SPSS) V.26.0 for analysis. Bivariate and multivariable logistic regression analyses were performed to identify presence of associations. Adjusted odds ratios (AOR) along with a 95% CI and P-value <0.05 were used to determine the strength of association and to declare statistically significance in the final model. Purposive sampling technique was used to select seven study participants for the qualitative approach. Transcripts were imported to ATLAS and then data was coded and analyzed thematically. Interviews were audio-recorded, transcribed verbatim, and translated from Amharic to English for analysis. A thematic content analysis was conducted using ATLAS.ti, involving transcript coding, subtheme grouping, theme refinement, and triangulation with observational data to ensure validity. Results: Adequate awareness of teratogenic risks associated with mood stabilizers among reproductive aged female patients with bipolar disorder attending follow-up treatment at Psychiatry OPD of Jimma Medical Center was 28.8% (95% CI: 22.1-36.3). Factors associated with adequate awareness were older age (AOR = 4.01, 95% CI: 1.12–14.5), higher education levels (AOR = 10.7, 95% CI: 1.62–21.5), longer duration of illness (AOR = 7.98, 95% CI: 1.32 18.2), previous pregnancy while on medication (AOR = 4.56, 95% CI: 1.12–18.7), current contraceptive use (AOR = 3.98, 95% CI: 1.06–14.9), pre-treatment pregnancy testing (AOR = 9.23, 95% CI: 2.70–31.6), counseling from healthcare professionals (AOR = 11.4, 95% CI: 1.39 23.1), and low perceived stigma (AOR = 3.64, 95% CI: 1.12–11.8). Qualitative insights revealed that discussions about these risks and contraception are infrequent and often initiated by patients, hindered by heavy workloads, limited resources, and cultural sensitivities among mental health providers. Conclusion: Approximately 71.2% of women with bipolar disorder at Jimma Medical Center were not adequately aware of the teratogenic risks of mood stabilizers. Adequate awareness was linked to older age, higher education, longer illness duration, prior pregnancy on mood stabilizer, contraceptive use, pre-treatment pregnancy testing, professional guidance, and low stigma. Qualitative findings show infrequent and reactive counseling, often patient-initiated or triggered by positive pregnancy tests. Heavy workloads, limited resources, and lack of standardized protocols hinder consistent risk discussions. Cultural sensitivities and assumptions of prior counseling lead to inconsistent, biased counseling, leaving women uninformed. This lack of communication leaves many women uninformed about their reproductive health, underscoring the need for standardized protocols and culturally sensitive counseling to bridge the gap in psychiatric care.