When I see epilepsy patients in clinic and online, I often encounter women with epilepsy who are going to be pregnant and worryingly ask: Doctor, which medication is the safest and has the least effect on the fetus? First, let me give the general picture. 1. In the United States, approximately 25,000 children are born each year to mothers with epilepsy, and in China, the number is certainly higher. 2, Most women with epilepsy need to take antiepileptic drugs during pregnancy to avoid seizures that could be harmful to the fetus. 3. In a normal population, the fetal malformation rate is 2-3%. The malformation rate increases 2-3 times in the offspring of women taking a single antiepileptic drug, and is even higher in the offspring of women taking multiple antiepileptic drugs. 4. 15-30% of women with epilepsy have increased seizures during pregnancy. 5. Seizures during pregnancy have incalculable effects on both the pregnant woman and the fetus. For the pregnant woman: miscarriage, premature birth, stillbirth, placental abruption, depression, psychiatric abnormalities, and increased pregnancy complications; for the fetus: bradycardia, fetal distress, neonatal hemorrhage, low birth weight babies, fetal developmental malformations, and acquired cognitive impairment; 6. secretion, but the concentration in breast milk is relatively low, and lactation is relatively safe for the vast majority of women taking antiepileptic drugs. Next, I describe the risk profile of commonly used antiepileptic drugs. 1. Sodium valproate (Depakene): it is definitely not recommended for use during pregnancy due to the anatomical and behavioral defects that cause the embryo to appear. 2. Lamotrigine: Improve the possibility of a wide range of blood medication get to fluctuate during pregnancy, is an increase in seizure frequency, should pay attention to adjust the drug dose, period to maintain a stable level. Lamotrigine belongs to the antagonist of folic acid, so there is a risk of teratogenicity, animal experiments have confirmed the teratogenicity of lamotrigine, and is dose-dependent. 3. Oxcarbazepine: Evidence suggests that oxcarbazepine monotherapy during pregnancy in women with epilepsy does not increase the risk of neonatal malformations. The fetal malformation rate for oxcarbazepine monotherapy was 2.4%, consistent with the odds of malformation in the overall population. To summarize, if women with epilepsy require antiepileptic drugs for seizure control, they should try to choose a single drug at a low dose depending on the type of seizure and avoid multiple drug combinations as much as possible. We recommend using the drug that is effective in controlling seizures but has the least associated risk. Try to avoid combination medications if you can use a single drug.