Pregnancy is a unique time in a woman’s life that is accompanied with numerous changes including hormonal and physiologic parameters. Sometimes these changes can become a challenge to underlying pre-existing disease conditions which could even have a negative effect on the pregnancy, labor or delivery.
In some cases pregnancy can have an adverse effect on some pre-existing neurologic disorders; on the other hand, certain neurologic disorders or their treatments can have negative effects on pregnancy. Thus, pregnancy in women with known neurologic diseases becomes a big issue as therapeutic decisions have to be then made keeping the well-being of the fetus in mind and the possible teratogenic effects of medications on it. The management of neurologic disorders depends heavily on the issue of striking a reasonable balance between the risk of stopping treatment versus the risk of treatment on the mother and her fetus.
Stopping treatment of the neurologic disease might result in its worsening, which would then require even higher doses of the medications which further increase their chances of being toxic to the developing fetus. It’s therefore important that medications be stopped only if stopping them won’t jeopardize the mother’s health; in such instances, the effect of the medication on the fetus becomes secondary. For instance, if anti-seizure medications are stopped abruptly, the instances of seizures could increase in the mother, and a cocktail of medications might be needed instead to control the situation, resulting in potentially greater harm to the fetus. So the question of using or not using the medication then becomes redundant; the next question that arises then is which treatment to continue and how it should be administered.
The ideal condition would of course be that a woman with a pre-existing neurologic disorder should first have a one-on-one discussion with her obstetrician and her neurologist on the possible effects and complications a future pregnancy would bring into her treatment regime. And more importantly, the woman with pre-existing neurologic disorder needs to know about the possible side-effects of her treatment before getting pregnant so that they don’t cause any malformations in the fetus. In the recent decades, there has been immense growth in the field of medicine and the therapeutic options for treatment of neurologic disorders have multiplied accordingly.
Certain drugs are available that are considered to be reasonably safe in pregnant women and your doctor can decide accordingly. There is another interesting turn of events that also occurs in pregnant women in some cases; pregnant women sometimes develop neurological disorders after getting pregnant, wherein the disorder is pregnancy-induced. The commonest of these is pre-eclampsia followed by eclampsia which results in seizures and sometimes heads into a stroke. Others include Reversible posterior leukoencephalopathy which can present with symptoms including seizures and blindness. Cerebral venous thrombosis is another cause of cerebral ischemic or cerebral hemorrhagic stroke and usually occurs post-delivery with symptoms of a sudden, severe headache, vomiting with or without weakness of limbs and loss of conciousness. These cases need to be managed in an ICU and may require surgical intervention as a life-saving measure.
Therefore, for successful management of neurological disorders in pregnancy, specialized care from both an obstetrician and a neurologist is required.Leave a reply