Many women with epilepsy are often concerned about the additional risks that may arise from pregnancy. Some women with epilepsy do carry a higher risk of complications after pregnancy than before, including increased seizure frequency during pregnancy, resulting in serious trauma if the woman faints or falls. In addition, some female patients may also experience a decrease in seizure frequency after pregnancy. The vast majority of women do not feel a significant change in seizure frequency during pregnancy, and those who have frequent seizures usually do so because they did not take their antiepileptic medications regularly during pregnancy as prescribed by their doctors. Others may not experience their first seizure until after pregnancy. The body’s utilization and metabolism of antiepileptic drugs may change during pregnancy, resulting in high (side effects) or low (more frequent seizures) drug concentrations. Your neurologist may increase your medication accordingly to control your seizures. For the safety of the mother and fetus, effective seizure control during pregnancy is essential. As mentioned earlier, pregnant women with epilepsy should never stop taking their medication without their doctor’s permission. Each patient responds differently to pregnancy and delivery, and this is something that requires assessment and close monitoring of the possible risks to the patient and fetus during pregnancy under the guidance of a physician. It is essential to keep your obstetrician informed about your epilepsy diagnosis and treatment, such as the dosage of antiepileptic drugs you are taking and the type of seizures you are having. In rare cases, tonic-clonic seizures (muscle rigidity with spasms) may result in miscarriage or fetal damage. Only about 1-2% of patients with poorly controlled epilepsy will have a tonic-clonic seizure during delivery; another 1-2% will have a type of seizure within 24 hours of delivery. Seizures can be controlled with antiepileptic drugs if they occur during delivery. In foreign countries, pregnant women with epilepsy who wish to deliver at home need to consider in advance the risk of complications from seizures that may occur during delivery. The same applies to water births, as the patient may become unconscious during a seizure. Patients can have a water birth at home or in the delivery room, where the warm water relaxes the muscles of the low back and pelvic floor, and the buoyancy reduces the burden of the fetal weight on the mother’s back and hips. The muscle relaxation effect and the buoyancy of the water can help the fetus to pass through the birth canal smoothly. The most common potential obstetric complications in pregnant women with epilepsy include vaginal bleeding, anemia, severe vomiting during pregnancy, and persistent severe vomiting during pregnancy requiring hospitalization. Frequent nausea and vomiting may lead to dehydration and vitamin-mineral deficiencies in pregnant women, who can lose more than 5% of their own body weight in water. Conditions that may be encountered during the perinatal period include preterm labor, obstructed labor, and an increased rate of cesarean deliveries to ensure basic safety for mother and baby. Approximately three million women of childbearing age in China have epilepsy. Patients may encounter problems during pregnancy regarding antiepileptic drug selection, timing of drug use, and how to control seizures, which need to be addressed with the combined efforts of the patient and family, the community, and the hospital. During pregnancy, issues such as the choice of antiepileptic medication, changes in hormone levels, and vitamin deficiencies can all have an impact on seizure profiles, even in patients whose seizures were well controlled before pregnancy. Sometimes these problems are combined with an underlying genetic defect in the patient herself, and there is a risk of mild or severe neonatal defects. Although these risks are often not enough to prompt a physician to advise a patient not to become pregnant, health care professionals still recommend that those pregnant women with current or previous epilepsy need to be extra careful and cautious. As mentioned earlier, the vast majority of patients’ seizure frequency remains the same during pregnancy, but about 20% of patients experience an increase in seizures during pregnancy. In other cases, the seizures only occur during delivery. A number of pathological changes, including hormone synthesis in the body, metabolic changes, stress states, and changes in sleep patterns, may contribute to the increased seizure frequency in some patients. During normal pregnancy, there is a natural and steady increase in estrogen and progesterone in the body. Whereas estrogen itself is an epileptogenic (increases seizure activity) substance, progesterone is thought to have a seizure suppressing effect. These fluctuating changes in hormone levels may make it more difficult for pregnant women to prevent and control epilepsy. Overall, sleep deprivation affects seizure frequency and significantly increases seizure frequency when pregnancy leads to changes in sleep patterns. The stress response and the associated changes in eating and sleeping habits may further contribute to increased seizures in some patients. Despite strict and regular use of appropriate doses of antiepileptic drugs, most patients will experience a decrease in blood levels during pregnancy. Many patients do not experience an increase in seizures in this setting, and those who do often do so because blood concentrations have fallen below the lower limit of the recommended effective concentration range for the drug. Therefore, close monitoring of patient blood levels during pregnancy is critical.