Pregnancy and postpartum pose a challenge for the illness course and treatment in bipolar disorder (BD). This article reviews the most updated data on the pregnancy and birth outcomes and child-bearing related course of illness together with treatment during pregnancy in BD. Two electronic databases, MEDLINE and SCOPUS were searched for the child-bearing related clinical studies and systematic reviews published in English. The reference lists of identified publications were also searched for other relevant publications. Data from a limited number of studies reveal an increased risk for small for gestational age and preterm births in women with BD. The results are inconclusive owing to the potential confounders, such as lifestyle and medication. Despite repeatedly reported high rates of episode recurrences during pregnancy, the exact impact of pregnancy on the course of illness in BD is equivocal. However, abrupt medication discontinuation sets a definite risk factor for significantly increased episode recurrences during pregnancy. Continuing lithium may be an option with a close fetal cardiac monitorization. However, avoidance from valproate is suggested. Safety data on the atypical antipsychotics remains inconclusive. There is no specific recommendation on the medication selection. Pregnancy is an event that may intersect the treatment course in women with BD. The exact impact of pregnancy on the course of BD and its subtypes is still to be explored, as is the role of confounding factors such as lifestyle and medication use on the adverse course of illness and birth outcomes.