Objective: The aim of this literature study was to investigate the association between psychotropic drugs taken during the first period of pregnancy and the risk of major congenital malformations. Background: Psychiatric disorders are common during the fertile years of life. About 50 percent of pregnancies are unplanned, and this number might be even higher among people with a psychiatric diagnosis. Women using psychotropic agents planning to become pregnant need guidance on this area. It is important to be able to guide these women with regard to adverse effects that different psychotropic medication might have on the fetus.Method: Using the search terms: psychiatric diagnosis pregnancyadverse effects and psychotropic drugs the Pub Med database were screened in order to find studies investigating the risk of congenital malformations in offspring exposed to psychotropic agents. Articles that focused on congenital malformations were selected unsystematically and thoroughly studied. Sources of reviews were also used if they were found suitable for the topic.Results: Risk of congenital malformation were found for antidepressants; TCA, SSRI and newer antidepressants, first and second generation of antipsychotic medication and mood stabilizers; lithium, carbamazepine, lamotrigine, valproic acid and gabapentin.Conclusions: For some psychotropic agents, valproic acid and carbamazepine, studies do show an association with congenital malformations. The studies were over all too small to discover moderate increased risks and too small to correlate the psychotropic agents to specific malformations. More studies are needed in this area, but randomized controlled studies on pregnant women are ethically not possible to do.