Neurological disorders in pregnancy

Abstract

Neurological disorders in pregnancy (NDPs) pose challenges to both obstetricians and neurologists. These diseases or their treatment may have adverse effects on the health of the fetus or complicate the course of the pregnancy, delivery, and postpartum period. Vice versa, the metabolic and endocrine changes associated with pregnancy may affect the mother’s neurological health. The care for a patient with an NDP is further complicated by the lack of clinical studies in this population, misinformation of patients regarding the risks associated with pregnancy when suffering from a neurological condition, and insecurity on the part of many physicians confronted with this constellation. Three different scenarios regarding the interdependency of pregnancy and neurological disease are possible. Most patients with NDPs suffer from a pre-existing condition such as epilepsy or multiple sclerosis, whose occurrence is unrelated to the pregnancy per se but nonetheless raises specific pregnancy-related concerns. The second group of NDP patients is afflicted with a neurological disorder observed with increased incidence during pregnancy (e.g. cerebrovascular disease and peripheral nerve compression syndromes). The third category comprises patients suffering from conditions exclusively seen in the pregnant, for example (pre-)eclampsia and amniotic fluid embolism. The subdivisions delineated here are reflected in the organization of this chapter. The aim is to provide a practical overview of the most frequent neurological conditions in childbearing women, highlighting the pregnancy-related issues and focusing on the management of these patients, which requires a highly interdisciplinary approach.