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Antiepileptic drugs in pregnancy and lactation

No antiepileptic drug is completely safe to use in pregnancy as the risk of fetal abnormality is increased. Valproate should be avoided if possible because of the risk of major malformations. Ideally a plan for managing the woman's epilepsy during pregnancy should be prepared before conception. The occurrence of an unexpected pregnancy should not trigger sudden cessation or alteration of antiepileptic drug treatment without medical advice. The smallest effective dose of a drug with a low risk of teratogenicity should be used. Doses may need adjustment as the pharmacokinetics of some drugs change during pregnancy. Data are limited, but most antiepileptic drugs seem to have little effect on full-term breastfed babies.