Medicine choices may be different in females with bipolar
disorder who may become pregnant – lithium, valproate
and carbamazepine are all associated with a risk of foetal
abnormalities (Pregnancy Risk Category D) and effective
contraception is recommended for all females of child-bearing
age who are taking these medicines.17 The risk to foetal
development is higher if these medicines are used in the first
trimester, or in combination.17 Valproate is associated with the
highest risk and should be avoided in women of child-bearing
age.17