A 27-year-old woman with bipolar I disorder presents to the PMHNP for her regular medication management appointment. She announces that she is 12 weeks pregnant with her first child. This pregnancy was unplanned, and the patient is worried about her medications causing harm to her unborn fetus. Which statement is true about bipolar disorder and pregnancy?

Choice A reason: Divalproex is associated with a high risk of neural tube defects and other congenital malformations when used during pregnancy, especially in the first trimester. It is not considered a safe alternative. Choice B reason: Lithium carries a risk of cardiac malformations, particularly Ebstein’s anomaly, when used during the first trimester. Its safety profile is complex and requires careful monitoring, especially during early pregnancy. Choice C reason: Carbamazepine is also teratogenic and associated with neural tube defects. It is not considered a safe alternative during pregnancy. Choice D reason: Clonazepam, a benzodiazepine, has not been strongly linked to major fetal malformations. While caution is still advised due to risks of neonatal withdrawal and