Female patients with epilepsy go through special physiological stages such as preparation for pregnancy, pregnancy, and breastfeeding, so the choice of antiepileptic drugs is related to the health of patients and their offspring. This article describes the medication considerations for women with epilepsy from the stages of preparation, pregnancy, contraception, and breastfeeding, and summarizes the relevant medications (see table below). Preparation for pregnancy Some antiepileptic drugs may affect the reproductive function, therefore, patients who have not yet given birth should try to avoid using drugs that may affect the reproductive function, such as valproic acid drugs. In addition, in addition to taking antiepileptic drugs, female patients with epilepsy in preparation for and during pregnancy need to take supplemental folic acid preparations. Animal studies have shown that antiepileptic drugs reduce serum folate levels and increase the risk of fetal neural tube defects. Neonatal malformations have also been associated with low maternal serum folate levels. All women of childbearing age with epilepsy should take folic acid supplements while taking antiepileptic drugs. Although there is no clear consensus on the dosage of folic acid, 5 mg of oral folic acid daily is reasonable for women of childbearing potential. Pregnancy The use of antiepileptic drugs has been associated with severe congenital malformations of the fetus, such as cleft lip and palate, cardiac malformations (ventricular septal defect, tetralogy of Fallot), genitourinary defects (hypospadias), and spina bifida, and studies have shown some variation in teratogenicity rates among different antiepileptic drugs, with some dose correlation. Therefore, medications with lower teratogenicity rates should be chosen for treatment as much as possible during pregnancy, but substitution of medications still needs to be weighed against seizure control. In addition, antiepileptic drug exposure may also affect offspring cognition, such as intrauterine exposure to valproate is associated with cognitive decline in children, and this risk may be dose-related. However, valproate may also be effective in certain types of epilepsy, such as juvenile myoclonic epilepsy. The risks and benefits of using the drug in patients of childbearing age or during pregnancy should be fully discussed with the patient and/or family to make a shared decision. Temporary substitution of valproic acid, such as in patients taking valproic acid who are already pregnant, is not recommended if seizures are well controlled. Contraception The use of antiepileptic drugs with heparanase enzyme-inducing properties affects the effectiveness of oral contraceptives, and thus there may be a risk of contraceptive failure; therefore, women with epilepsy are advised to use other methods of contraception that are not based on oral medications, such as instrumental contraception. In addition, oral contraceptives may also affect the concentration of antiepileptic drugs, which in turn may affect the efficacy of antiepileptic drugs, e.g., all estrogen-containing contraceptives may reduce serum lamotrigine concentrations, leading to worsening of epilepsy control, and therefore the dose of lamotrigine may need to be adjusted if and when the contraceptive is discontinued. The main enzyme inducers in classical antiepileptic drugs are phenytoin, carbamazepine, phenobarbital, and paracetamol, and oxcarbazepine, one of the newer antiepileptic drugs, also has enzyme-inducing properties. Breastfeeding There is no evidence that indirect exposure to antiepileptic drugs through breastfeeding has clinically significant effects on the offspring; the potential risks of breastfeeding should be balanced by the benefits of breastfeeding to the newborn and the mother, and women with epilepsy should be counseled about the pros and cons of breastfeeding. Pramipexole, levetiracetam, barbiturates, benzodiazepines, lamotrigine, gabapentin, topiramate, and zonisamide are likely to significantly penetrate into breast milk, and therefore patients taking these medications should be informed in detail about the pros and cons of breastfeeding. In conclusion, female epileptic patients as a special patient group, the use of antiepileptic drugs should take full account of the special physiological stages of pregnancy, contraception, breastfeeding and other reasonable use of medication, pre-pregnancy, pregnancy and postpartum regular monitoring of blood concentration, timely adjustment of drug dosage. >>The medication recommendations of the Chinese Guidelines for the Management of Peri-Pregnant Women with Epilepsy developed by Chinese experts: 1. Considering that the golden age of women in childbearing is shorter, and that most low-dose AEDs have a lower risk of teratology, for women who are on combination therapy, it is not recommended to completely stop the medication and then become pregnant, and the medication should be adjusted according to the patient’s specific situation (Grade D recommendation): a. Changing to a single drug at a low dose; b. Replacing a single drug with a high teratogenic rate; c. Replacing a single drug with a high teratogenic rate. . replace high teratogenicity drugs; c. maintain the original regimen, but reduce the dose. 2. It is recommended that when preparing for pregnancy, newer AEDs should be preferred, valproic acid should be avoided if possible, and the lowest effective dose of monotherapy should be maintained as much as possible (Grade A recommendation). 3.For female patients who are already using valproic acid, it is recommended to re-evaluate and try to switch to other AEDs instead before considering pregnancy (Grade C recommendation). 4. For women with unplanned pregnancies who are using valproic acid, if seizures are well controlled, temporary replacement of valproic acid during pregnancy is not recommended, and adjusting to a lower dose is sufficient; if seizures are poorly controlled, try replacing them with newer AEDs that have faster onset of action, or add newer AEDs, and maintain a lower dose of valproic acid (Grade D recommendation). 5. In patients with epilepsy treated with monotherapy AEDs, breastfeeding is encouraged (Grade B recommendation). Avoid phenobarbital, benzodiazepines, and topiramate as much as possible; in the case of patients treated with multidrug combination therapy, artificial feeding may be considered (Grade D recommendation).