With 0.3-0.7% of pregnant women worldwide suffering from epilepsy, discontinuation of antiepileptic drugs (AEDs) during pregnancy is likely to make it difficult to control seizures in pregnant women and thus increase maternal and fetal mortality. The questions of whether AEDs during pregnancy can cause fetal malformations, whether a pregnant woman can pass on epilepsy to her child, and whether AEDs during pregnancy can affect the mental and emotional development of the child are questions that continue to plague women of childbearing age and clinicians. The rational choice of AEDs for pregnant women with epilepsy has important clinical implications. Previous data studies have found that the most teratogenic antiepileptic drug is valproic acid (9.3%), followed by phenobarbital (5.5%), followed by topiramate (4.2%), carbamazepine (3.0%), phenytoin (2.9%), levetiracetam (2.4%), and lamotrigine (2.0%). Therefore, the correct selection of AEDs and dose adjustment are particularly necessary. I. Teratogenicity of traditional AEDs 1. Phenobarbital: associated with cleft lip and palate and cardiovascular malformation in infants; 2. The fetal valproic acid syndrome can even be serious. The teratogenicity of new AEDs 1. Lamotrigine: Lamotrigine is the drug of choice for the treatment of idiopathic generalized epilepsy and symptomatic partial epilepsy in women of childbearing age, and is usually used in combination with other AEDs; studies have pointed out that when maternal lamotrigine intake exceeds 300 mg/d compared with normal intake, the infant is deformed. The rate of infant malformations is significantly higher when maternal lamotrigine intake exceeds 300 mg/d compared to normal intake. Since the drug clearance of lamotrigine is significantly higher during pregnancy, resulting in lower blood concentration in pregnant women, lamotrigine blood concentration testing should be closely monitored during pregnancy. 2, Topiramate: In 1996, the United States began to use this drug widely for the treatment of epilepsy, and the U.S. Food and Drug Administration has now identified it as a Class D drug in pregnancy (Class D: positive evidence of risk to the human fetus, but although harmful, it needs to be definitely beneficial to pregnant women before it is applied.) Cases of fetal microcephaly, congenital absence of fingers or toes, short fingers, toe deformities, intrauterine growth retardation, hirsutism, cleft lip deformities, and urethral malformations have been reported in pregnant women after taking topiramate. 3.Oxcarbazepine: Oxcarbazepine had been widely used in North America, some retrospective reports prove that single treatment with this drug may be associated with infant malformation. Gabapentin: Gabapentin is prone to interact with other AEDs and may reduce its bioavailability. The drug has not been found to be significantly associated with infant malformations. 5. Levetiracetam: Levetiracetam is the first-line drug for women of childbearing age with generalized seizures. It is considered to be the safest AEDs in terms of side effects. Eslicarbazepine: Eslicarbazepine is a third-generation dibenzazepine antiepileptic drug, mainly used as an adjunctive treatment for partial-onset seizures in adults. 2013 U.S. Food and Drug Administration approved its clinical use and rated it as a Class C drug in pregnancy (Class C: proven to have side effects on the fetus in animal studies). (Class C: drugs with proven side effects on the fetus in animal studies, such as malformations or embryonic lethality or other, but no control group in women or no available information in women and animal studies. Drugs should be given only when the benefits outweigh the harms to the fetus and only when the potential benefits outweigh the potential risks to the fetus. Malformed infants delivered to pregnant women with epilepsy may be due to the administration of AEDs during pregnancy rather than the effect of genetic factors in the mother. All AEDs are somewhat teratogenic compared to the number of malformed infants delivered by pregnant women with epilepsy who did not take AEDs. Among them, valproic acid was significantly dose-dependent in relation to infant physical malformations and cognitive deficits. The complexity of classifying infant malformations, the ease with which many physical malformations are overlooked at birth, and the difficulty of testing cognitive abilities in children at 2-3 years of age make clinical studies very difficult. Studies have not yet found that AEDs are fully associated with a fixed type of malformation. The teratogenicity of new AEDs is less than that of conventional AEDs, but they are generally used as adjunctive treatment for antiepilepsy, and data on the teratogenicity of their single-agent use remain inconclusive. In addition, the teratogenicity of combination drug therapy is not higher than that of monotherapy.