How do you tailor seizure medications in patients who become pregnant or are family planning?

There are basic guidelines for planning pregnancy: folate 4 mg QD, good prenatal care. All seizure medications are basically comparable except valproate as far as birth malformation. Monotherapy if possible, and low dose if possible. Modern medications are generally preferred over old ones.

For the 50% of pregnancies that are unplanned, changing seizure medications after 6 weeks has little or no impact.