Epilepsy is a common neurological disorder and has a prevalence of 5.25 per 1000 pregnancies. Managing epilepsy during pregnancy is to balance maternal and fetal risks associated with uncontrolled seizures against the potential teratogenic effects of antiepileptic drugs (AEDs). A rational approach requires knowledge of such risks as well as an understanding of effect of pregnancy on seizure control and on metabolism of AEDs. The levels of many AEDs change (decline) during pregnancy and these changes revert postpartum necessitating change in drug dosage. Women with AEDs have twice the risk of fetal congenital malformation compared to general population. Polytherapy is associated with major risk of congenital malformation than monotherapy. Several of these drugs cause fetal hydantoin syndrome characterized by craniofacial anomalies (mildly dysmorphic face and fingers with stubby distal phalanges), fingernail hypoplasia, developmental delay, cardiac defects and facial clefts. Valproate and carbamazepine have been associated with neural tube defects specifically spina bifida. Valproate is also associated with cognitive impairment and developmental delay in babies born to mothers on AEDs. Seizure control before pregnancy is as important as their control in pregnancy. Folic acid supplementation in the dose of 5 mg/day should be started 3 months before conception. Changes in the dose of AEDs if required should be done before conception. Counseling of the couple regarding compliance of drugs and risk of teratogenicity must be done. Antenatal management includes emphasizing the need for regular intake of drugs to achieve optimal drug levels and fetal evaluation for congenital malformations. Lorazepam or diazepam are the drugs of choice in women with seizures during labor or if the women goes into status epilepticus.