Suicide remains a significant public issue. Several concordant information exists suggesting that patients diagnosed with severe and persistent psychiatric disorder (SPPD) show relatively higher rates of deaths by suicide compared with patients suffering from other mental illness. In particular, recent researches have demonstrated that, in pregnant women with history of SPPD, a percentage ranging from 13.1% to 33.0% of mothers may have suicidal ideation. Both psychopathological and social specificities of women with SPPD must force clinicians to consider any suicidal expression shown by these mothers as a signal of possible high-lethality suicide attempts. Because of the vast majority of maternal suicidal deaths due to psychiatric disorder usually occur before week 20 of gestation, the necessity exists to analyze and summarize published literature information on the teratogenic risk of antisuicidal drugs and somatic treatments also associated with the property to reduce the rate of self-aggressive behaviors, in order to identify the safest option to treat suicidal risk during early pregnancy. Further, the difficulties of managing the suicidal risk during the last stages of pregnancy are briefly summarized.