BACKGROUND: Pregnant women with bipolar disorder often elicit conflicts between maternal and fetal considerations. CASE: A 26-year-old primigravida at 12 weeks' gestation presented for emergency psychiatric evaluation after discontinuing psychotropic medications when starting prenatal care. She developed worsening depression and was suicidal. She was admitted to an inpatient psychiatric unit, medication was reinitiated, and she appeared to stabilize well enough to be followed as an outpatient. Two days after discharge, she shot herself in the left chest, resulting in her death and that of her fetus. CONCLUSION: When choosing to maintain or discontinue mood stabilizers during pregnancy, decisions are best made by the use of a risk-benefit model that takes into account the health and well-being of both mother and fetus.