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Women with bipolar disorder should consult with their health care providers if they are pregnant or trying to conceive since some medications used for bipolar disorder may be associated with teratogenicity (the risk of birth defects in the fetus). It is also important for women considering pregnancy to seek genetic counseling, as there is a significant risk for genetic transmission of bipolar disorder. Currently, data regarding the effect of untreated bipolar disorder on the fetus is lacking.

The risk of continuing or discontinuing medications must be carefully assessed as to the effect on the mother's symptoms and quality of life. For some women, medication may be discontinued during the first trimester and then resumed for the duration of the pregnancy. According to the American Psychiatric Association first trimester exposure to lithium, divalproex, and carbamazepine is associated with a 1-5% risk of birth defects.

Lithium carries the risk of cardiovascular defects (0.2%)

Divalproex carries the risk of:

• Neural tube defects
• Craniofacial abnormalities
• Limb malformations
• Cardiac defects

Carbamazepine carries the risk of:

• Neural tube defects
• Craniofacial abnormalities

High potency antipsychotic agents are not thought to be teratogenic and may be considered an alternative to lithium for treatment of mania during pregnancy. To date, there are no definitive conclusions regarding the teratogenicity or other effects on the newborn of the newer atypical antipsychotics (e.g., risperidone, olanzapine). Tricyclic antidepressants and serotonin selective reuptake inhibitors (SSRIs) have not been associated with birth defects.

The American Psychiatric Association regards ECT as a potential treatment for severe mania or depression during pregnancy, commenting that the risk to the fetus of short-lived anesthetics is less than that of certain drug therapies.