Some women continue taking bipolar medications and have healthy babies. But some bipolar medications cause an increased risk of birth defects in the first trimester, such as:

• Neural tube defects.
• Heart defects.
• Developmental delay or neurobehavioral problems.

However, you must weigh these risks against the risks of untreated bipolar disorder. It can lead to behaviors such as these, which can also harm a baby:

• Poor prenatal care.
• Poor nutrition.
• Increased use of alcohol or tobacco.
• Stress and trouble with attachment.

Your doctor may suggest stopping gradually or changing medication. Or you may continue with medication and do regular tests to check on the health of your baby. But whatever you do, don't stop taking medications without first talking with your doctor.

Was your pregnancy unplanned? If so, know that the period of greatest concern may have already passed once you learned you were pregnant. Stopping medications suddenly may do more harm than good.

Mood stabilizers. Studies show that taking multiple mood-stabilizing medications is riskier than taking just one. Here's what is known: because of the risk for heart defects, lithium is not usually recommended during the first three months of pregnancy. But if you need a mood stabilizer, it may be a safer choice than others. And, when continued after childbirth, it can reduce the rate of relapse from 50% to 10%.

To reduce its risks to you and your child:

• Drink plenty of water to prevent lithium toxicity.
• Have lithium levels checked often -- in you and your child -- especially if you are breastfeeding.

Both valproate (Depakote) and carbamazepine (Tegretol) may lead to birth defects such as neural tube defects. And, most experts say it is a good idea to stop them during pregnancy. You may need to switch to another drug.

There is less information on the safety of newer anticonvulsants. However, lamotrigine (Lamictal) may be a useful alternative for some women.

Antipsychotic medications. Antipsychotic medications can be used during acute treatment of mania, especially to manage delusions or hallucinations. Examples of newer antipsychotics include:

• Aripiprazole (Abilify).
• Olanzapine (Zyprexa).
• Quetiapine (Seroquel).
• Risperidone (Risperdal).
• Ziprasidone (Geodon).

Your doctor may suggest that you switch during pregnancy to an older-generation antipsychotic such as haloperidol (Haldol). This may also be a good idea if you've stopped taking a mood stabilizer but experienced a recurrence of symptoms.

Antidepressants. There is less data about the effects of antidepressants on bipolar disorder and pregnancy. If you are on antidepressants, your doctors will watch you closely for mood switches or the acceleration of cycling. Also know that these drugs may increase the risk of mania. This is especially true if mood stabilizers have been stopped.

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