Epilepsy is one of the most common diseases of the central nervous system (CNS), affecting about 1% of the population. Women suffering from epilepsy of reproductive age who want to become pregnant represent a high-risk group of patients who are a challenge for doctors when prescribing the correct therapy to control the disease. For women diagnosed with epilepsy, pregnancy planning is recommended, in order to adjust the therapy in time, choose the right medicine, in the right (effective and safe) dose. Various factors are taken into account when choosing a drug, especially evidence on the safety of drug use during pregnancy, as well as data on adverse effects on the mother and child. The aim of this review is to investigate the safety, effectiveness, advantages and disadvantages of the use of certain antiepileptic drugs during pregnancy, as well as to show the connection with congenital malformations and other risks during embryo-fetal development, during childbirth and later development of the newborn. The use of antiepileptic drugs during pregnancy can lead to a number of unwanted effects, including large and small congenital malformations with serious consequences for the functioning and subsequent development of the child. Medicines for which the greatest risk of adverse effect on the fetus is noted are valproic acid, phenytoin, phenobarbital, carbamazepine, topiramate and should be avoided during pregnancy, especially in the first trimester. Levetiracetam, brivaracetam and lamotrigine stand out among the most prescribed drugs, as well as those that show the lowest risk for congenital malformations and other side effects. Despite the risks, with a proper approach to patients, regular monitoring of drug concentrations during pregnancy and adequate supplementation with folic acid and vitamin K, most women bring their pregnancy to an end with good disease control and the desired pregnancy outcome.