The risk of developing or exacerbating psychiatric disorders increases in the perinatal period. However, there is a concern that psychotropic medications may be withheld from appropriate treatment by doctors, or patients or their families because of concerns about their effects on the fetus or infant. This article describes psychiatric disorders with risk of perinatal onset or exacerbation and presents the risks and benefits of standard pharmacotherapy to the fetus and infant. It is essential to consult with the patient and family before conception to make shared decisions based on correct information.