Women with epilepsy have many legitimate concerns regarding the effects of their condition and the use of antiepileptic drugs (AEDs) on their unborn children. These concerns fall into 4 areas: increased seizure frequency during pregnancy, risk of birth defects, risks associated with breast- feeding, and psychomotor retardation in offspring. Studies have shown that many of these risks can be minimized with appropriate management and counseling. Data also show that psychomotor retardation in offspring of mothers with epilepsy is generally transitory. In this article, associations between maternal use of AEDs, birth defects, intrauterine growth retardation, and the psychomotor development are discussed together with how best to alter AED therapy to minimize them.