Approximately one million women with epilepsy in the United States are in their active reproductive years. Many women with epilepsy require treatment during pregnancy, and many antiepileptic drugs (AEDs) are potential teratogens. Unfortunately, many pregnancies are often not identified until after organ formation has occurred. However, most women with epilepsy will have a normal pregnancy and a favorable outcome. Effective control of maternal seizures with the least risk to the fetus is ideal, but maternal and fetal risks are still likely increased over the general population. In 2009, the American Academy of Neurology (AAN) and the American Epilepsy Society (AES) published Practice Parameter Updates on the pregnant woman with epilepsy.123 These guidelines reviewed medications, teratogenicity, obstetric outcomes, vitamins, breastfeeding, and other management issues in the pregnant woman with epilepsy. Through a case-based approach, these guidelines will be reviewed, and approaches to diagnosis and management of the pregnant woman with epilepsy will be discussed.