How do you treat epilepsy in pregnancy?

E pilepsy affects millions worldwide and women of childbearing age constitute between 25% and 40% of all patients with epilepsy. Estimates based on the population in the United States in the 1990s approximate that 25,000 children are born to women with epilepsy (WWE) annually. For WWE who are pregnant or planning to become pregnant, providers should consider the potential risks regarding seizure control, obstetric complications, and teratogenicity of antiepileptic drugs (AEDs) when counseling patients and determining a treatment plan. Studying pregnant women poses unique challenges. Randomized control trials are difficult to conduct in this population, and much of the available data is observational by necessity, which precludes many studies from reaching the most rigorous levels of evidence. Several aspects of the care of pregnant WWE are discussed in this commentary, with a special focus on teratogenicity and drug monitoring.