Pregnancy is a highly important period which presents also many concerns and questions for every woman. This period is particularly challenging for women with epilepsy because of the risks associated with antiepileptic drugs. It is important to balance maternal and fetal risks due to uncontrolled seizures and the potential teratogenity of antiepileptic drugs. The aim of this review was to summarize new data about the management of epilepsy during pregnancy. We describe fetal and maternal risks associated with seizures, as well as teratogenic risks associated with anticonvulsant exposure (including intrauterine growth, major congenital malformations, and developmental and behavioural outcomes). Also information about changes in the metabolism of antiepileptic drugs during pregnancy and seizure control during this period is presented. Based on these data, some recommendations are provided on how to better manage women with epilepsy before, during and after pregnancy.