Objective To analyze the efficacy of levetiracetam combined with lamotrigine in the treatment of gestational epilepsy and its effect on pregnancy outcomes. Methods A total of 76 patients with gestational epilepsy in the outpatient or inpatient departments of Suzhou Municipal Hospital Affiliated to Nanjing Medical University from Jan. 2017 to Feb. 2021 were included, including 20 cases in levetiracetam monotherapy group, 22 cases in lamotrigine monotherapy group and 34 cases in combined treatment group (levetiracetam combined with lamotrigine). The epilepsy frequency, pregnancy-related complications and adverse pregnancy outcomes were compared among the 3 groups. Results The proportions of patients with no epilepsy, no change in epilepsy frequency, increase in epilepsy frequency and decrease in epilepsy frequency during pregnancy were 82.3% (28/34), 2.9% (1/34), 5.8% (2/34) and 8.8% (3/34) in the combined treatment group, 45.0% (9/20), 25.0% (5/20), 15.0% (3/20) and 15.0% (3/20) in the levetiracetam monotherapy group, and 45.5% (10/22), 13.6% (3/22), 18.2% (4/22) and 22.7% (5/22) in the lamotrigine monotherapy group, respectively, and the differences were significant among the 3 groups (P<0.05). There were no significant differences in pregnancy-related complications or adverse pregnancy outcomes among the 3 groups (all P>0.05). Conclusion The efficacy of levetiracetam combined with lamotrigine in the treatment of gestational epilepsy is better than that of monotherapy. It can reduce the frequency of gestational epilepsy without increasing the incidence of pregnancy-related complications and adverse pregnancy outcomes.