Women with epilepsy may be especially concerned that the risk of pregnancy complications and birth defects could be higher because of seizures and because the baby will be exposed to antiepileptic drugs (AEDs). Most women with epilepsy can become pregnant and have healthy children. However, their pregnancies are subject to a greater risk of complications, difficulties during labor, and a risk of adverse outcomes. Women with epilepsy are at greater risk for other obstetric complications during pregnancy. Fetal death appears to be as common and perhaps as great a problem as congenital malformations and anomalies. A hemorrhagic phenomenon has been described in the infants of mothers with epilepsy. Perinatal lethargy, irritability, and feeding difficulties have been attributed to intrauterine exposure to AEDs, especially to phenobarbital and phenytoin. Risks can be minimized by the preconceptual use of multivitamins with folate and by using AED in monotherapy with the lowest effective dose.