5 Neurological Disorders in Pregnancy

We’re familiar with the threat of common diseases like gestational diabetes and pre-eclampsia in pregnancy. In addition to that, the nervous system can also be stricken with diseases that can turn into a health crisis in this delicate period of pregnancy and childbirth. These neurological disorders carry several symptoms that range from minor discomforts to medical emergencies. Therefore, being familiar with what these are will allow you to be more aware in identifying red flags. 

1. Pregnancy Headache

The surge of hormones and the increase in blood volume often result in frequent headaches in expectant moms. It’s a common discomfort during the first and third trimesters, which are usually challenging stages during pregnancy. 

Aggravating factors include: 

• Stress
• Lack of sleep
• Nausea and vomiting
• Dehydration
• Sinus congestion or nasal stuffiness
• Pregnancy-induced hypertension (PIH)
• Low blood sugar levels
• Poor nutrition

These trigger two of the most common types of headaches which are, tension headaches and migraines. 

Tension Headache

Due to the physical toll that pregnancy has on the body, tension headaches are likely to occur. This is why it’s also referred to as stress headaches. 

These are felt as mild to moderate pressing pain on both sides of the head, similar to having a tight band wrapped around it. This sensation is usually accompanied by a sore neck and shoulder. It resolves within a few minutes to a few hours, and in rare cases, it can last for several days. 

Migraine

Migraines, on the other hand, aren’t your typical headaches. It’s characterised by severe, throbbing pain that comes with neurological symptoms like blurred vision, numbness, flashes of light or tingling on the face, arms, or leg. 

Women with regular migraine headaches may notice that they experience fewer episodes during pregnancy. Some may encounter it for the first time after getting pregnant, while others experience the same frequency. However, some may notice it getting worse especially during the first trimester. 

These episodes should not be taken lightly because expectant women who suffer from migraines have a greater risk of hypertensive diseases associated with pregnancy. 

A person can experience both tension headache and migraine, and their symptoms may overlap. Therefore, pregnant women should be quick to have a doctor check unexplainable and persistent headaches. Even more so if this is accompanied by symptoms like sudden dramatic weight gain or puffiness in the face or hands. 

A person can experience both tension headache and migraine, and their symptoms may overlap. Therefore, pregnant women should be quick to have a doctor check unexplainable and persistent headaches. Click To Tweet

Tests and scans may be needed to determine the cause behind these headaches. Blood pressure levels will be checked routinely. The OB-GYN may also order blood tests, blood sugar tests, a vision test or a scan of the head and neck if serious. 

Ways to cope with pregnancy headaches

Besides medical interventions, there are non-pharmacologic measures to treat headaches during pregnancy. You may try any of the following:

• Stay hydrated.
• Eat well-balanced meals.
• Relieve tension headaches by applying a cold compress or ice pack at the base of your neck. 
• Maintain blood sugar levels by eating small, frequent meals. 
• Rest in a dark room and practice deep breathing exercises.
• Take a warm bath or shower.
• Get a neck or shoulder massage.
• Relax and get plenty of rest.
• Practice good posture.
• Put your feet in a tub of warm water.

Medical treatments for pregnancy headaches vary depending on the different factors that surround it. While we often reach for over-the-counter pain medications to counter any bouts of headache, in this case, a doctor’s advice is necessary to ensure that any measures taken don’t compromise a pregnancy or the health of the baby. Common painkillers found in pharmacies that fall under the NSAID group (including the patches) are contraindicated while some paracetamol (panadol) can be taken in safe doses.

2. Epilepsy

Epilepsy is a neurological disorder that involves recurrent seizures. In every 1000 pregnancies, between 2-5 infants are born to mothers who have it. However, most of these women remain free of seizures during pregnancy and even move on to have uncomplicated pregnancies and healthy babies. 

How pregnancy affects epilepsy

It’s difficult to predict how pregnancy affects epilepsy. However, some may experience frequent seizures while they’re pregnant. The reason for it is that the medications used to treat epilepsy may work differently during pregnancy, or it may not be absorbed well. It might be the case that expectant women are no longer taking it regularly or have stopped taking it entirely. Furthermore, the physical and emotional stress that comes with pregnancy are also considered as potent triggers. 

How epilepsy affects pregnancy

On the other hand, epilepsy poses certain risks to pregnancy. Besides general complications that come with the condition, the medications used to treat it can also have adverse effects on the mother, the unborn baby, and the pregnancy. 

Since women are at a more delicate state while pregnant, having a seizure disorder heightens the risk for injuries and complications. Maternal risks include trauma from falls, bumps, or accidentally biting the tongue. Meanwhile, the type of medications may have serious side effects to the baby, such as abnormalities to the heart, slightly smaller size, birth defects (e.g. cleft lip or cleft palate), or stillbirths. In addition, the risks to the pregnancy itself may result in the premature separation of the placenta from the uterus, premature labour, and miscarriages. 

So what can be done to ensure a safe pregnancy even in the presence of a seizure disorder? 

Pregnant women with epilepsy need close monitoring of the disease and fetal health, which means that there will be more frequent prenatal visits needed.  Click To Tweet

Pregnant women with epilepsy need close monitoring of the disease and fetal health, which means that there will be more frequent prenatal visits needed.  

Most women will be prescribed with anticonvulsant medications. Proper monitoring also follows to ensure that seizures are controlled and side effects are reduced. The goal of treatment is to use as few medications as possible at the lowest dose necessary to control these seizures. 

There is also a particular need to increase folic acid dosage in pregnant women with epilepsy. This prenatal vitamin is routinely prescribed to all pregnant women to reduce the risk of babies having defects to the spine, heart, and limbs. However, there is a need to prescribe a higher dose because epilepsy medications can interfere with folic acid absorption increasing the risk of the baby being born with spinal abnormalities. Conversely, special monitoring is needed to check if folic acid hasn’t lowered the blood levels of these seizure medications. Otherwise, it could increase the risk of seizures. 

While epilepsy medications come with risks, they should not be discontinued or changed without consulting a healthcare professional. Poorly controlled epilepsy may result in a very rare but serious complication called sudden unexplained death with epilepsy (SUDEP), which is highly likely to occur during the time of delivery and the postpartum period. 

3. Multiple Sclerosis

Multiple Sclerosis (MS) is an autoimmune disorder that affects the central nervous system, which is the brain and spinal cord. In this disabling disease, the body mistakenly attacks the myelin sheath, which is an outer coating that protects the nerve cells. When it gets damaged, the flow of information between your brain and the rest of the body gets disrupted. This leads to common neurological symptoms such as loss of coordination, muscle weakness, and trouble with sensation. 

Multiple sclerosis and pregnancy

Having MS doesn’t seem to affect getting pregnant, and neither does pregnancy speed up the course or worsen the effect of MS. In fact, the nine months of pregnancy are generally associated with fewer relapses, especially during the third trimester. Those with unrecognized MS prior to getting pregnant are more likely to start experiencing symptoms during pregnancy. However, within 3-6 months after delivery, the symptoms usually tend to flare up again. 

Challenges MS pose on pregnancy

Due to debilitating symptoms, it may be physically challenging for MS patients to carry a pregnancy. It increases the likelihood of injuries due to muscle weakness and coordination problems. Meanwhile, fatigue may also be felt more profoundly. 

With pelvic sensation compromised, a woman may not feel pain with contractions. While this may sound like a dream come true, the absence of any sensation can be hard for a woman to tell when labor starts and even its progression. Furthermore, delivery becomes difficult as the muscles and nerves needed for pushing are also affected. It is for this reason that these patients usually undergo a C-section, a vacuum delivery, or a forceps delivery. 

Currently, there is no available treatment for MS, but there are medications that can help control the symptoms. Since relapse is unlikely during pregnancy, there is usually no need for any medications. However, drug therapies may have to be resumed after pregnancy which means that breastfeeding may not be advised; but these can be arranged based on how the disease progresses. 

One can always consult a doctor or OB for any concerns – whether if it’s about getting pregnant, any advise on pregnancy, or close monitoring. Just like other neurological disorders, the presence of MS will require more frequent prenatal visits. 

You can read about a Singaporean mum’s struggle with MS, here. 

4. Myasthenia Gravis

Myasthenia gravis (MG) is another autoimmune disorder that causes weakness to the skeletal muscles of the face and extremities. It worsens after periods of activity, and improves after periods of rest. It usually affects women who are in their 20s and 30s, or during the childbearing years. 

MG tends to worsen during the first trimester and postpartum period. One study showed that 30% of patients do not experience any change in their MG status, 29% reported improvement, and 41% showed worsening of their MG symptoms during pregnancy. However, the course of the disease varies and pregnant women face the risk of it getting worse, respiratory failure, adverse drug reactions, a myasthenic crisis, and even death. 

Labour and delivery for women with MG

Pregnancy does not appear to worsen the long-term effects of MG on women. Vaginal delivery is safe, and it should be encouraged. A c-section is carried out only when there is a need to because surgery is associated with worsening of MG, and it might even result in a myasthenic crisis. 

Since the uterine muscles are composed of smooth muscles, its ability to contract is not compromised with MG. Therefore, the first stage of labour is not affected. But as the woman progresses to the second stage of labour, she will need the striated muscles to work. This can be exhausting and it often requires the need for forceps or vacuum extraction.

Another complication of labour with a higher incidence in mothers with MG is premature rupture of membranes holding the amniotic fluid, although the reason for it is unclear. 

Effects of MG on the baby

Infants who are born to women with MG are thought to develop neonatal MG through the passage of MG antibodies between mother and fetus. The symptoms are usually mild to moderate, which is observed through poor sucking and muscle tone. Generally, this is temporary, and the baby’s symptoms disappear within two to three months after birth. 

Treatment of MG during pregnancy

Treatment must be individualised based on the severity of MG as well as the effectiveness of various treatment options and their possible harmful effects on pregnancy. Optimal management during this delicate period calls for a multidisciplinary team approach comprising an obstetrician, neonatologist/pediatrician, and neurologist. 

For those planning to get pregnant, but are also struggling with MG, doctors would often advise to delay pregnancy for at least 2 years following diagnosis. The severity of symptoms and risk of maternal death is highest within this period. Most myasthenic women can have an uneventful pregnancy with good outcome as long as there is careful planning and close monitoring.

5. Peripheral Neurological Disorder

The disorders mentioned above are issues that affect the central nervous system. But there are also conditions that target the nerves outside the brain and and spinal cord, and these are called peripheral neurologic disorders. 

There are over 100 types of these neuropathies, but the ones common to pregnancy are carpal tunnel syndrome and Bell’s palsy. These conditions are usually due to compression during pregnancy and childbirth. 

Carpal Tunnel Syndrome (CTS)

Carpal Tunnel Syndrome affects 4% of the general population, but it is more common during pregnancy where it is 31%-62% of pregnant women. Click To Tweet

Carpal Tunnel Syndrome affects 4% of the general population, but it is more common during pregnancy where it is 31%-62% of pregnant women. Experts could not pinpoint the root cause behind it, but they suspect that it could be hormone-related swelling. Increased fluid and relaxation of the ligaments puts pressure on the nerve on the wrist, called the median nerve, as it passes through the carpal tunnel in the wrist. 

There are certain factors that increase a woman’s risk of developing CTS during pregnancy. Aggravating factors include obesity, gestational diabetes, pregnancy-related hypertension, and having previous pregnancies.

Read: Gestational Diabetes: Why It Is No Sweet Talk 

Most doctors recommend treating CTS conservatively during pregnancy because patients experience relief weeks or months after giving birth.

Treatments that can safely be applied during pregnancy include the use of splints to keep the wrist in a neutral position. This also controls the motion to the wrist, like when one types on the keyboard. Proper rest, especially when the affected hand feels painful or fatigued. Elevating the wrists and applying a cold compress can help relieve the symptoms. On top of that, doctors may also prescribe physical therapy and pain relievers. 

Bell’s Palsy

Bell’s palsy is a temporary weakness of facial nerve. It can strike at any age and it occurs without warning. It’s more common during pregnancy, with most cases occurring during the third trimester and postpartum period. The symptoms are often confused with that of a stroke, which is why it must be evaluated immediately. 

Bell’s palsy is a temporary weakness of facial nerve. It can strike at any age and it occurs without warning. It’s more common during pregnancy, with most cases occurring during the third trimester and postpartum period. Click To Tweet

There are several theories as to why pregnant women are more likely to experience Bell’s palsy than non-pregnant women. Below are the following reasons: 

• Increased total body water which causes swelling and/or compression of the facial nerve
• Increased blood clotting factors
• Weakened immune system
• Elevated levels of the female hormones, estrogen and progesterone

In general, those who experience Bell’s palsy will experience a full recovery within 6 months. Unfortunately for Bell’s palsy during pregnancy, the prognosis for complete recovery isn’t as great as the general population, 52% vs. 80%, respectively. It should be noted that the poorer outcomes reported are likely related to the past reluctance of physicians to prescribe steroids and antivirals in treatment. Today, management of Bell’s palsy in pregnancy should mirror that of nonpregnant individuals and include steroids combined with antivirals, with the exception of first trimester cases. Steroids help to reduce swelling and compression of the nerve and anti virals may aid in Bell’s palsy secondary to a viral infection. 

Neurologic disorders may come with symptoms that can make pregnancy more challenging, even to a point of being risky. However, it doesn’t mean that having these conditions can rob a woman of bearing a child.  With preparation, precaution, and close monitoring, it’s possible to have a safe pregnancy. 

Whether you are still planning for a baby or drafting your birth plan, it’s important that you have the right professional help to guide you along. In Singapore, Dr. Pamela Tan provides warm, caring, and personalised obstetric and gynaecological services for every woman’s unique concerns.  Make an appointment today!