Objective: To compare the cognitive and language development of children born to women with epilepsy (WWE) exposed in utero to levetiracetam (LEV) or sodium valproate (VPA) and control children born to women without epilepsy not taking medication during pregnancy. Methods: The children, aged between 36 and 54 months, were recruited from the United Kingdom and assessed using the Griffiths Mental Development Scales and the Reynell Language Development Scale. Maternal demographic and epilepsy information was also collected for use in statistical regression. This is an observational study with researchers not involved in the clinical management of the mothers enrolled. Results: After controlling for confounding variables, children exposed to LEV in utero (n = 53) did not differ from unexposed control children (n = 131) on any scale administered. Children exposed to VPA (n544) in utero scored, on average, 15.8 points below children exposed to LEV on measures of gross motor skills (95%confidence interval [CI] 224.5 to 27.1, p > 0.001), 6.4 points below on comprehension language abilities (95% CI 211.0 to 21.8, p = 0.005), and 9.5 points below on expressive language abilities (95% CI 214.7 to 24.4, p > 0.001). Conclusion: The current study indicates that children exposed to LEV in utero were superior in their language andmotor development in comparison to children exposed to VPA. This information should be used collaboratively between health care professionals and WWE when deciding on women's preferred choice of antiepileptic drug.