Table 4.

Medications for Bipolar Disorder in Pregnancy^a

Agent	Characteristic Adverse Outcomes	US Food and Drug Administration Pregnancy Class	Rate of Major Congenital Malformations and Major Adverse Events With In Utero Exposure, %b
Antipsychotics	Haloperidol has not been associated with teratogenesis or poor outcomes; chlorpromazine is associated with infant respiratory distress syndrome; atypical antipsychotics have not been associated with fetal abnormalities, but have been associated with gestational diabetes, which may lead to poor outcomes	C (except clozapine, class B)	Limited data, no apparent increase
Lithium	Associated with floppy infant syndrome, thyroid toxicity, and rare cardiac defects (Ebstein's anomaly)	D	4–12
Valproate (includes divalproex and valproic acid)	Neural tube defects, fetal valproate syndrome	D	6–20
Carbamazepine	Neural tube defects, fetal carbamazepine syndrome	D	2–8
Lamotrigine	None reported	C	1–6

^aBased on Cohen²³ and Nguyen et al.²⁴

^bRate in general population is 2% to 4%.