Purpose of Review <p>Epilepsy, a seizure disorder, is one of the most common chronic neurologic disorders in pregnancy, currently affecting up to 0.8% of all pregnancies. Pregnancies complicated by epilepsy have increased risks of adverse maternal and fetal outcomes. This review will summarize essential considerations for managing pregnancies in people with epilepsy, including maternal and fetal risks in pregnancy, antiseizure medication (ASM) use in pregnancy, intrapartum and postpartum management, breastfeeding, and contraception.</p> Recent Findings <p>This review assesses recent literature and summarizes current management practices in people with epilepsy during pregnancy. Current literature supports the utilization of newer generation ASMs (such as levetiracetam, lamotrigine, topiramate) for reproductive-aged people with epilepsy when applicable, as these are generally more tolerable, less teratogenic, and safer for breastfeeding than older generation ASMs (such as phenobarbital, phenytoin, carbamazepine, valproate). However, pregnancies in people with epilepsy remain high risk for complications, even with the use of newer generation ASMs. These increased risks include early pregnancy loss, stillbirths, preterm birth, cesarean delivery, and severe maternal morbidity (SMM). Multidisciplinary care with Neurology and Obstetrics is critical for optimizing pregnancy outcomes in people with epilepsy.</p> Summary <p>People with epilepsy should be managed closely before, during, and after pregnancy with multidisciplinary care from Obstetrics and Neurology. Maintaining good seizure control with the implementation of newer generation ASMs has improved maternal and neonatal outcomes. However, there continues to be an increased risk of adverse obstetric outcomes in this high-risk population. Close monitoring throughout pregnancy with a multidisciplinary team is essential to mitigate these risks.</p>