There is evidence that lithium salts, valproate, carbamazepine, and paroxetine are associated with a risk of fetal malformation and should therefore be avoided during the first trimester. The most significant problem with lithium salts is the risk of cardiovascular malformations, with an incidence of approximately 1.2%-7.7%, of which tricuspid valve insufficiency (Ebstein Anamoly) is the most severe, although its absolute risk rate is very low (1/1000). The risk of neural tube developmental defects is mainly associated with valproate and carbamazepine, especially valproate, which can occur at rates as high as 6%. Lamotrigine is relatively safe, although recent data suggest a possible association with harelip/cleft palate. Little information is available on atypical antipsychotics, all of which are classified by the FDA as Category C (i.e., risks cannot be excluded). All current antidepressant risk assessments are also classified as Category C (except paroxetine and bupropion); paroxetine should be avoided during pregnancy because of its possible association with neonatal cardiovascular malformations; and bupropion is classified as Category B (there is no evidence of risk in humans), so it may be a priority if antidepressants are needed during pregnancy. Benzodiazepines are also to be avoided during the first 10 weeks of pregnancy (because of the risk of causing harelip/cleft palate). If a relapse of affective disorder occurs during the first 3 months of pregnancy, use non-pharmacological psychosocial treatment whenever possible. If the risk of disease recurrence is greater than the risk of teratogenicity of the treatment medication, modified electroconvulsive therapy (MECT) or pharmacological treatment should be considered to control the episodes of mindfulness. The choice of treatment options for different stages of pregnancy needs to be based on the potential adverse effects of the medication, e.g., for acute manic episodes in the first trimester, a class C atypical antipsychotic is appropriate, while for bipolar depressive episodes, MECT or quetiapine is appropriate. Although other antidepressants may be considered, such as bupropion or SSRIs (except paroxetine), a combination of atypical antipsychotics is needed to reduce the risk of transient mania. Because pregnancy increases the body fluid volume ratio, medication maintenance patients need to increase the dosage in mid- to late-pregnancy to ensure steady-state blood levels and efficacy, but the dosage needs to be reduced in the days before delivery to avoid toxic effects. Patients must be informed of the increased risk of fetal death, fetal growth retardation, and neonatal toxicity associated with the use of psychotropic drugs in mid- to late-term pregnancy. In addition, there have been reports indicating that valproate use during pregnancy may be associated with lower speech IQ development in children.