The risks to offspring from second-generation, or atypical, antipsychotic medications used by pregnant women have not yet been established in blinded or randomized studies. Yaeger et al. (p. 2064 CME) describe the case of a woman with paranoid schizophrenia to illustrate important considerations in the decision to continue, change, or stop treatment with an atypical antipsychotic during pregnancy. They stress the importance of optimizing the mother’s health and ability to parent. The pregnancies of women with schizophrenia often are unplanned, suffer from complications, and result in loss of custody. Discussions about contraception and pregnancy should therefore begin early in treatment. The medical risks associated with antipsychotics, such as obesity, diabetes, and hypertension, indicate a need to coordinate care during pregnancy with the patient’s obstetrician. After childbirth, dramatic hormonal changes may necessitate an increase in the antipsychotic dose, and additional social support may be helpful in preventing relapse. The benefits of breast-feeding during antipsychotic treatment are likely outweighed by the risks.