Awareness About Neurological Disorders During Pregnancy
The joy of motherhood is unmatched but to ensure that pregnancy is enjoyable and the baby is healthy, it is important that the woman remains healthy during pregnancy. It is important to know that a pregnant woman is susceptible to a number of neurological disorders and there are some other neurological diseases that may flare up during this phase of a woman’s life. Thus, It is essential to know about these disorders to take adequate care and prevent or treat them on time.
The Neurological Disorders
In Chorea Gravidarum (CG), abnormal involuntary movements of the limbs (arms or legs) occur in pregnancy. This condition is rare but is more common in first pregnancies and symptoms usually start ¡n the first trimester. Patient may appear fidgety or restless and movements could be clumsy.
Symptoms get worse with stress and disappear during sleep. The common underlying causes include rheumatic fever, autoimmune disease such as antiphospholipid syndrome, etc.
Eclampsia is characterized by high blood pressure, proteinuria (leakage of protein in the urine), headache, swelling of feet/hands, seizures (convulsions) and/or coma (loss of consciousness). This condition usually occurs in the third trimester of pregnancy (and sometimes after 20 weeks of gestation) or in the post-partum period (a few days after delivery).
Primigravida (those pregnant for the first time) are more prone to develop eclampsia. In severe cases of eclampsia, the heart, kidneys and liver may also get affected and a patient needs to be treated in an ICU.
Neurological Disorders Aggravated During Pregnancy
Migraine is the commonest cause of headache in pregnant women. A woman with a history of migraines can get more frequent headaches during pregnancy but some women may start getting their first migraine attack during pregnancy. Increased frequency of headaches in pregnancy is related to the presence of migraine triggers such as tension, stress, irregular meal timings, vomiting, etc. during pregnancy. For relieving headaches due to migraine, paracetamol tablets are safe.
Epilepsy is a condition, whereby a person has repeated seizures or fits. Seizure frequency may increase in about one-third of pregnant women. This is attributed to three mechanisms – increase in body weight, rapid metabolism of seizure medications in the liver and poor compliance with antiepileptic medications (due to the fear of pregnancy complications).
Women who are seizure-tree for two or more years may discontinue anti-seizure medications (under supervision of a neurologist) before planning a pregnancy.
All other women with epilepsy should be on anti-epileptic medications. preferably a single drug, at the lowest effective dose. Folic acid supplementation should be provided to all pregnant women.
Stroke is a condition In which either the blood supply to a part of brain is reduced (brain ischemia) or there is bleeding in the brain (brain haemorrhage), resulting in paralysis. The incidence of stroke is increased during pregnancy as well, as in post-partum period. This ¡s because pregnancy is considered to be thrombogenic (increased risk of clotting of blood). Another type of stroke, called cerebral venous sinus thrombosis (CVST) typically occurs in pregnancy or in postpartum period.
In CVST, there is clotting of blood in brain veins, which may result in headache, blindness, loss of consciousness, paralysis, and coma. Blood tests are usually done to detect any deficiency of other factors, which may cause clotting of blood in brain veins. The diagnosis can be suspected on clinical basis and it can be confirmed with MRI scans of the brain. Patients respond well to anticoagulation therapy (blood thinners such as heparin).
A pregnant woman is susceptible to a number of neurological disorders and there are some other neurological diseases that may flare up during this phase of a woman’s life
Neurological Disorders That May Improve During Pregnancy
Pregnancy does not only have negative effects, but on the contrary, can make some neurological disorders get better.
Multiple sclerosis (MS) is more common in young women of childbearing age. This disease affects the brain, spinal cord, and optic nerves. Patients with MS can have various problems such as weakness, numbness, imbalance, decreased vision, etc. However, it has been observed that there are fewer disease relapses of MS during pregnancy. If there is MS relapse during pregnancy, steroids can be safely taken.
Women who get migraine attacks only during periods tend to have a good time’ during pregnancy as headache episodes are fewer during pregnancy. The improvement in migraine could be related to uniformly high and stable levels of estrogen throughout pregnancy.
Pregnancy is a mixed bag. It brings immense joy and pleasure in anticipation of the new arrival. Nevertheless, the knowledge and awareness of neurological diseases will prepare a woman (and family) to better enjoy the bliss pregnancy brings.