- The antiepileptic drug regarded as the safest for use during pregnancy is Lamotrigine.
- It is preferred due to its relatively lower risk of major congenital malformations compared to other antiepileptic drugs such as Valproate, Phenytoin, and Carbamazepine.
- However, despite its safer profile, Lamotrigine has been associated with an increased risk of oral clefts, including cleft lip and cleft palate, when used in pregnancy.

- Valproate is well known for its high teratogenic risk, particularly neural tube defects, cognitive impairment, and major malformations; therefore, it is generally avoided during pregnancy.
- Phenytoin carries a risk of fetal hydantoin syndrome, which includes growth deficiency, microcephaly, and craniofacial anomalies.
- Carbamazepine is associated with a moderate risk of neural tube defects, though less than Valproate.
- Lamotrigine, in contrast, has a consistently lower overall risk of major congenital malformations and is often chosen when seizure control during pregnancy is necessary.
- However, multiple studies have shown that Lamotrigine use in pregnancy can increase the risk of oral clefts, which are specific congenital malformations involving the lip and/or palate.

Thus, while no antiepileptic drug is entirely risk-free during pregnancy, Lamotrigine is considered the safest option for seizure control with a lower overall teratogenic profile but a notable association with oral clefts.

Reference: *Epilepsy, 5th Edition, Vol 1, Chapter 14: "Management of Epilepsy During Pregnancy"*