Neurologic Diseases and Pregnancy

Neurological or neurologic diseases can be medically defined as disorders that affect your brain, the nerves of the spinal cord, and the nerves found throughout the body. Biochemical, structural, or even electrical abnormalities in the spinal cord, brain, or other nerves of the body can cause a variety of symptoms in neurological disorders.¹

Neurological diseases affect millions of people each year, and many people simply remain unaware that they actually have a neurological disorder.

Some neurologic diseases can have little or no effect on a pregnancy, while others can significantly increase the risk of having complications, maternal and fetal illness, and also increase the risk of a miscarriage or stillbirth. Here are some of the common neurological conditions and how they may impact your pregnancy.

One of the most common neurological disorders during pregnancy is experiencing headaches. A medical review found that 39 percent of pregnant and postpartum women experience moderate to severe headaches.¹¹ In fact, headaches are one of the most common neurological disorders, and there are a wide variety of different types of headaches, including tension headaches, cluster headaches, and migraines.

It is likely, though, that during pregnancy, you may get a different type of headache than you commonly do, and most headaches during pregnancy are not harmful or dangerous to the baby and mother.

Headache during the first trimester of the pregnancy typically happens for a variety of reasons, as compared to the headaches you experience during the second or third trimester. In rare cases, a headache might be a sign of some other health issue during pregnancy. It is important to let your doctor know about any headache you have had before, during, and after pregnancy. You can try maintaining a journal to keep a record of how often you experience these headaches and how severe the pain is. Also, keep track of any other symptoms you have at the time.

Most headaches you have during pregnancy are primary headaches, meaning that the headache pain is happening by itself, and it is not a sign of any other complication in the pregnancy. Primary headaches include tension headaches, cluster headaches, and migraine headaches, and nearly 26% of all headaches during pregnancy are tension headaches.¹²

If you have chronic headaches or migraines during pregnancy, or you have a history of migraines, you should let your doctor know in your first-trimester itself. Some women with a migraine history tend to experience fewer migraine attacks during pregnancy. In some cases, migraine headaches are also linked to complications that occur later in the pregnancy or after birth.

Secondary headaches, though, are usually caused by a complication in the pregnancy, especially high blood pressure.

If you have been regularly taking headache medication before pregnancy, talk to your doctor before taking the medication during pregnancy. It is not recommended to take ibuprofen ad aspirin (brand names Motrin, Advil, etc.) during pregnancy. The Center for Disease Control and Prevention has issued warnings against taking pain relief drugs as they can be harmful to the growing baby, especially during the first trimester.¹³

Your doctor will recommend certain alternative medications to treat headaches during pregnancy, and you can use some natural headache remedies, including:

• Ice pack
• Rest
• Drinking plenty of water
• Massage
• Exercise and stretching
• Heating pad
• Essential oils like chamomile, peppermint, and rosemary

Having multiple sclerosis (MS) does not mean that you can’t start a family. The disease does not have to stop you from getting pregnant, and neither does it hurt your unborn baby. The odds are mostly that your pregnancy and delivery will be similar to those of women who do not have MS. Nevertheless, pregnant women with MS may face some unique challenges during pregnancy.

The good news is that pregnancy does not appear to speed up the course or worsen the symptoms of MS. However, if you have unrecognized MS, it is more likely that you will start having symptoms during your pregnancy. Some studies have discovered that MS symptoms actually decrease during pregnancy and then again increase after delivery.¹⁴

However, the disabling effects and symptoms of this disease may make it physically challenging for some women to carry a pregnancy to full term. Coordination problems along with muscle weakness caused by MS can increase the likelihood of falls. You are also likely to find yourself feeling more tired. Women who are wheelchair dependent are going to be at an increased risk for urinary tract infections.¹⁵

It is essential to know that MS does not affect fertility in any way. However, studies have shown that certain types of fertility treatments can increase the risk of flare-ups in women with MS. Relapse rates have been found to be higher in the three months following in vitro fertilization. At the same time, another recent study has not found any increase in flare-ups after taking fertility treatments. Research is still ongoing in this area, and more data will hopefully become available in the future.^16,17

During your pregnancy, though, you will need to be closely monitored to keep track of the disease and the health of your growing baby. You are likely to need more frequent prenatal visits, and you may be prescribed medications like anti-inflammatory drugs and steroids. Remember that supportive treatment and rehabilitation for MS become even more critical during pregnancy. Rehabilitation techniques will vary from person to person depending on your symptoms, but they may help with the following during pregnancy:

• Maintaining independence
• Doing everyday daily tasks
• Using assistive devices like walkers, braces, and canes
• Re-establishing motor skills
• Setting up an appropriate exercise program that promotes muscle endurance, control, and strength.
• Managing bladder or bowel incontinence
• Adapting the home environment for usability and safety
• Providing cognitive retraining, if needed
• Improving communication skills if you have trouble speaking due to lack of coordination or weakness of the tongue and face muscles.

In women with MS, labor might be demanding as you might not have any pelvic sensation and might not be able to feel labor pain and contractions. This might make it difficult to know when labor starts. While the actual labor process is usually not affected by MS, the delivery of the baby might be more challenging when you have MS. This is because MS can impact the muscles and nerves that are needed for pushing the baby out. For this reason, many doctors recommend women with MS to have a cesarean delivery or delivery with the help of a vacuum or forceps.

For most women with epilepsy, it is possible to have a healthy pregnancy and go on to give birth to a normal and healthy baby. However, it is important that you take extra care during your pregnancy. Studies have shown that by taking precautions and following your doctor’s recommendations, the chances of women with epilepsy having a healthy child is over 90 percent.18,19 While there are many increased risks, but working together with your doctor can help minimize these risks.

Women with epilepsy should talk to their obstetrician and neurologist before trying to conceive. Most doctors will recommend that women with epilepsy should be under the care of a high-risk obstetrician during the course of their pregnancy.

There is a chance that having epilepsy may make it difficult for you to conceive. It has been observed that women with epilepsy have fewer children than women who don’t have epilepsy. The fertility rate of women with epilepsy is between 25 to 33 percent, which is lower than average.²⁰

If your epileptic seizures are not under control, it is likely to affect your fertility. Experts say that if you are having seizures around the time of your ovulation, the seizures are likely to disrupt the signals that kick-start the process of ovulation.²¹

Once you become pregnant, the most important thing to focus on will be to control your seizures. Having seizures during pregnancy can have an impact on the health of your baby. Seizures may cause you to fall, or the baby might be deprived of oxygen during the seizure, which can not only harm the baby but also increase the risk of miscarriage or stillbirth.

You may need to continue taking certain epilepsy drugs during your pregnancy, which might increase the risk of a birth defect. While in the general population, the risk of having a child with a birth defect is just 2 to 3 percent, women with epilepsy have a risk of 4 to 8 percent.²²

Several studies have found that women with epilepsy tend to have naturally low folate levels in their blood. Unfortunately, many of the commonly prescribed epilepsy drugs that control seizures, such as valproate, valproic acid, and phenytoin, are linked with a higher risk of having a child with congenital disabilities. This is because these drugs lower the concentrations of certain forms of folate in the bloodstream.²³

Many women with epilepsy worry about having a seizure during labor. While seizures are not common during the labor and delivery process, but they are always a possibility. If you experience a seizure during labor, your doctor will give you intravenous medication to stop the seizure. If this does not work, you might need to have a cesarean delivery. However, most women with epilepsy have been found to have normal vaginal deliveries, though they do have a higher rate of cesarean deliveries than women who don’t have epilepsy.²⁴

Women with epilepsy are likely to worry about these challenges, but there is no need to become overly anxious. It is important that you are aware of the risks, but remember that a majority of women with epilepsy go through their pregnancy without having any major problems. The chances of having a healthy child even if you have epilepsy are excellent.

The most common neurologic conditions during pregnancy may include:

• Migraine headaches
• Multiple sclerosis
• Epilepsy/seizures
• Sciatica
• Stroke

It is important to remember that most neurologic diseases do not have any major impact on pregnancy. However, they may increase the risks of developing complications. At the same time, pregnancy-related complications such as high blood pressure can also create neurological problems, even if you never had them before.

If you have any type of neurological disorder, your doctor is likely to recommend you to a high-risk obstetrician, who, together with your neurologist, will carefully monitor your pregnancy. Women with neurological diseases can increase their chances of a healthy pregnancy and a healthy baby by seeking early and regular prenatal care and by working with their healthcare team to manage their disease properly.

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