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We conducted a systematic review of the literature to determine the prevalence of mood episode recurrences during pregnancy among women with bipolar disorder. Included studies (n = 11) had wide variation in the reported proportions of pregnant women with bipolar disorder who experienced a recurrence (median = 24%, range = 4-73%). There is some evidence that pregnant women are more likely to have a depressive or mixed episode, rather than hypomanic or manic. The extant literature cannot answer the question of how pregnancy affects the course of bipolar disorder; it merely informs us of the effect of medication discontinuation during pregnancy.