The care and treatment of women with psychiatric disorders in pregnancy is both challenging and complex. The decision to treat or not treat can pose a risk to the mother, the developing fetus or infant and the pregnancy outcome. Treatment options can be both pharmacologic and non-pharmacologic. The risk and benefit of treatment is a shared decision between the woman and her obstetrical and mental health providers. There is no definitive answer to the optimal treatment of psychiatric disorders in pregnancy. The ideal treatment would minimize the risk to the developing fetus and enable the mother to have few or no psychiatric symptoms during pregnancy.