Pregnancy in women affected with bipolar disorders supposes a complex clinical decision making process for those women affected and their clinicians. On one hand, a careful weighing of potential consequences of maintains pharmacologic treatment for obstetric health and embryo-fetal development is essential. On the other, a thorough consideration of risks of discontinuing treatment for pregnant women and fetal health is needed. In this paper, critical items to discuss with women that make informed decisions regarding their mood stabilizing treatment in these complex circumstances are described. Likewise, some clinical recommendations for psychiatric management of pregnancy in this population are presented.