Quick take: Pregnancy doesn’t “pause” bipolar disorder. The risk of relapse is higher if mood stabilizers are stopped. Many patients can continue medication with careful planning. Valproate is generally contraindicated in pregnancy; lithium and lamotrigine are commonly considered with monitoring. Never stop meds abruptly—plan with your clinician and OB. (Project Teach NY)

Why this matters

Pregnancy and postpartum are periods of higher relapse risk for bipolar disorder—especially if medications are discontinued. The priority is maternal stability and risk–benefit balancing for mother and baby. (Project Teach NY)

Planning before conception (or as early as possible)

Medication choices during pregnancy (high-level)

• Lithium: Effective for mania and maintenance; requires serum level monitoring (levels change across trimesters), hydration guidance, and fetal cardiac screening (e.g., targeted ultrasound in 2nd trimester if 1st-trimester exposure). (Project Teach NY)
• Lamotrigine: Often used for bipolar depression/maintenance; dose adjustments may be needed due to increased clearance in pregnancy. (Psychiatry Online)
• Atypical antipsychotics (e.g., quetiapine): Reasonable options; available data do not show major teratogenic signals, but metabolic monitoring is important. (Psychiatry Online)
• Valproate: Avoid in pregnancy (teratogenicity, neurodevelopmental risks). (Project Teach NY)
• Benzodiazepines: Use sparingly; ACOG recommends avoiding or using only when necessary for perinatal anxiety. Project Teach NY

Key ACOG guidance (2023): Don’t discontinue mood stabilizers except valproate purely because of pregnancy/lactation—relapse risk is substantial. Shared decision-making and close monitoring are essential. (Project Teach NY)

Postpartum planning

• Highest risk window for relapse and postpartum psychosis is the early postpartum period—proactive prevention matters.
• Sleep protection plans, partner/family support, lactation-compatible medication strategies, and early follow-up are crucial. (ACOG)

Breastfeeding considerations

• Many medications can be compatible with breastfeeding; decisions weigh infant exposure vs. maternal stability and relapse prevention. Coordinate among psychiatry, pediatrics, and OB. (See ACOG guidance.) (ACOG)

Psychotherapy and supports

• Psychoeducation, relapse prevention planning, CBT/interpersonal therapy, and structured routines complement medication.
• Build a postpartum sleep plan (night feed coverage, pumping schedules) to reduce sleep-loss triggers.

Safety

• If you have thoughts of self-harm, feel out of control, or suspect postpartum psychosis (severe insomnia, racing thoughts, paranoia, hallucinations), seek urgent help or call 988. (SAMHSA)

At CHARIS MIND & BODY WELLNESS

• Preconception consults to align psychiatry + OB plans
• Evidence-based medication management (lithium/lamotrigine strategies, level monitoring, dose adjustments)
• Sleep protection and postpartum relapse prevention plans
• Coordination with pediatric and lactation teams

Next step: Book a perinatal psychiatry consult. We’ll review your history and build a personalized plan you can trust.

References & guidelines: ACOG 2023 guideline on treatment during pregnancy/postpartum; NICE perinatal mental health; APA resources; recent reviews on lithium/lamotrigine in pregnancy. (Psychiatry Online; Project Teach NY; ACOG)