Half of the women diagnosed with a mental health condition requiring regular medication have previously given birth to children. A dilemma arises when deciding whether to continue medication to treat the mother’s illness or potentially cease or replace medication in the interests of their child. This study endeavors to examine the challenges associated with prescribing psychotropic medications to pregnant women experiencing mental health disorders. Its primary objective is to furnish a checklist delineating essential considerations for prescribers in such cases. The investigation underscores the pivotal equilibrium required in addressing the mental health of the mother while mitigating risks to the developing fetus. The paper delves into the nuances of decision-making within this framework, highlighting the importance of a collaborative health-care approach coupled with personalized treatment strategies. These strategies may encompass modifications in medication regimens and the incorporation of non-pharmacological interventions. The prescription of psychotropic medications to pregnant women with mental health conditions presents complex challenges and demands consideration. Striking a critical balance is imperative, as it entails managing the mother’s mental health while minimizing potential risks to the developing fetus. The decision-making process is nuanced, influenced by factors such as the teratogenic potential of specific medications, the risk of neonatal withdrawal syndrome, and the potential for adverse outcomes in maternal and fetal health if psychiatric conditions remain untreated. Pre-conception counseling and maternal-fetal medicine services are beneficial tools in navigating this balance. Predictors of the necessity for medication during pregnancy include the patient’s diagnosis, severity of prior episodes, and responsiveness to treatment. The dynamic landscape of pharmaceutical research underscores the importance for prescribers to actively engage with evolving literature, ensuring the provision of accurate and up-to-date advice. Effective shared decision-making is of paramount significance in instilling confidence and assuring the patient.