Evaluation of the Neurological Complaints during Pregnancy and Postpartum

Authors

  • Afshin Borhani-Haghighi 1. Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran 2. Department of Neurology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
  • Shaghayegh Zafarmand Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
  • Haniyeh Javanmardi 1. Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran 2. Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
  • Maryam Ameri Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
  • Masoud Maneshi Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
  • Susan Mansouri-Mehrabadi Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
  • Yasaman Zolghadrasli Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
  • Mahshad Moazzam Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
  • Ayda Aramesh Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

DOI:

https://doi.org/10.31661/gmj.v8i.1616

Keywords:

Neurological Disorders, Pregnancy, Postpartum

Abstract

  • Background: Pregnancy and postpartum are critical periods for patients with neurological complications. In this study, we aimed to evaluate the clinical characteristics and outcome of pregnant women with neurological conditions. Materials and Methods: This cross-sectional study reviewed pregnant women with neurological signs and symptoms, who were registered in the Medical Care Monitoring Center (MCMC) database of Shiraz University of Medical Sciences 2013-15. A questionnaire was designed to record each patient’s information including demographic variables, past medical history, clinical presentation, obstetric profile, and fetal/maternal outcomes. Results: Totally, 332 mothers were registered in the database. The main neurological complaints in our population were headache, seizure, unilateral neurological symptoms, multiple sclerosis, neuromuscular disorder, and brain tumor. More than half of the patients (54%) experienced headache during the pregnancy and postpartum period. Conclusion: Evaluating the neurological disorders separately, based on the time of symptom onset indicates the importance of follow-up of mothers during peripartum. Our findings suggest that decisions for pregnancy in women with neurological disorders should be based on risks outweighing for the mother and the fetus, particularly regarding the pharmacological side effects. [GMJ.2019;8:e1616] 

References

Block HS. Neurological complications of pregnancy. Curr Neurol Neurosci Rep. 2016 Jul;16(7):67. https://doi.org/10.1007/s11910-016-0665-2PMid:27230113 Kanekar S, Bennett S. Imaging of neurologic conditions in pregnant patients. Radiographics. 2016 Nov;36(7):2102-22. https://doi.org/10.1148/rg.2016150187PMid:27831835 Guntupalli KK, Karnad DR, Bandi V, Hall N, Belfort M. Critical illness in pregnancy: part II: common medical conditions complicating pregnancy and puerperium. Chest. 2015 Nov ;148(5):1333-45. https://doi.org/10.1378/chest.14-2365PMid:26020727 Ferraz Z, Parra J, Areia AL, Vasco E, Moura P. Acute Onset Neurological Disorders during Pregnancy: A Literature Review. Rev Bras Ginecol Obstet. 2017 Oct;39(10):560-8. https://doi.org/10.1055/s-0037-1604058PMid:28651292 Allais G, Chiarle G, Sinigaglia S, Mana O, Benedetto C. Migraine during pregnancy and in the puerperium. Neurolog Sci. 2019 May 1;40(1):81-91. https://doi.org/10.1007/s10072-019-03792-9PMid:30880362 Negro A, Delaruelle Z, Ivanova TA, Khan S, Ornello R, Raffaelli B, Terrin A, Reuter U, Mitsikostas DD. Headache and pregnancy: a systematic review. J Headache Pain. 2017 Dec;18(1):106. https://doi.org/10.1186/s10194-017-0816-0PMid:29052046 PMCid:PMC5648730 Sandoe CH, Lay C. Secondary Headaches During Pregnancy: When to Worry. Curr Neurol Neurosci Rep. 2019 Jun;19(6):27. https://doi.org/10.1007/s11910-019-0944-9PMid:31011857 Warnock JK, Cohen LJ, Blumenthal H, Hammond JE. Hormone-Related Migraine Headaches and Mood Disorders: Treatment with Estrogen Stabilization. Pharmacotherapy. 2017 Jan;37(1):120-8. https://doi.org/10.1002/phar.1876PMid:27888528 Allais G, Chiarle G, Sinigaglia S, Mana O, Benedetto C. Migraine during pregnancy and in the puerperium. Neurolog Sci. 2019 May 1;40(1):81-91. https://doi.org/10.1007/s10072-019-03792-9PMid:30880362 Chen HM, Chen SF, Chen YH, Lin HC. Increased risk of adverse pregnancy outcomes for women with migraines: a nationwide population-based study. Cephalalgia. 2010 Apr;30(4):433-8. https://doi.org/10.1111/j.1468-2982.2009.01935.xPMid:19614685 Wainscott G, Sullivan FM, Volans GN, Wilkinson M. The outcome of pregnancy in women suffering from migraine. Postgrad med j. 1978 Feb 1;54(628):98-102. https://doi.org/10.1136/pgmj.54.628.98PMid:634879 PMCid:PMC2425078 Lewis DJN. American Academy of Neurology Quality Standards Subcommittee; Practice Committee of the Child Neurology Society. Practice parameter: pharmacological treatment of migraine headache in children and adolescents: Neurology. 2004;63:2215-24. https://doi.org/10.1212/01.WNL.0000147332.41993.90PMid:15623677 Viale L, Allotey J, Cheong-See F, Arroyo-Manzano D, Mccorry D, Bagary M, Mignini L, Khan KS, Zamora J, Thangaratinam S, EBM CONNECT Collaboration. Epilepsy in pregnancy and reproductive outcomes: a systematic review and meta-analysis. The Lancet. 2015 Nov 7;386(10006):1845-52. https://doi.org/10.1016/S0140-6736(15)00045-8 Vajda FJ, O'Brien TJ, Graham JE, Hitchcock AA, Lander CM, Eadie MJ. Predicting epileptic seizure control during pregnancy. Epilepsy Behav. 2018 Jan 1;78:91-5. https://doi.org/10.1016/j.yebeh.2017.10.017PMid:29179105 Tomson T, Lindbom U, Ekqvist B, Sundqvist A. Epilepsy and pregnancy: a prospective study of seizure control in relation to free and total plasma concentrations of carbamazepine and phenytoin. Epilepsia. 1994 Jan;35(1):122-30. https://doi.org/10.1111/j.1528-1157.1994.tb02921.xPMid:8112234 Borthen I. Obstetrical complications in women with epilepsy. Seizure. 2015 May 1;28:32-4. https://doi.org/10.1016/j.seizure.2015.02.018PMid:25843764 Yerby M, Koepsell T, Daling J. Pregnancy complications and outcomes in a cohort of women with epilepsy. Epilepsia. 1985 Dec;26(6):631-5. https://doi.org/10.1111/j.1528-1157.1985.tb05703.xPMid:3841052 Sveberg L, Svalheim S, Taubøll E. The impact of seizures on pregnancy and delivery. Seizure. 2015 May 1;28:35-8. https://doi.org/10.1016/j.seizure.2015.02.020PMid:25746572 Danielsson KC, Borthen I, Morken NH, Gilhus NE. Hypertensive pregnancy complications in women with epilepsy and antiepileptic drugs: a population-based cohort study of first pregnancies in Norway. BMJ open. 2018 Apr 1;8(4):e020998. https://doi.org/10.1136/bmjopen-2017-020998PMid:29691249 PMCid:PMC5922520 Hiilesmaa VK, Bardy A, Teramo K. Obstetric outcome in women with epilepsy. Am J Obstet Gynecol. 1985 Jul 1;152(5):499-504. https://doi.org/10.1016/0002-9378(85)90615-5 Tanganelli P, Regesta G. Epilepsy, pregnancy, and major birth anomalies: an Italian prospective, controlled study. Neurology. 1992 Apr;42(4 Suppl 5):89-93. Richmond JR, Krishnamoorthy P, Andermann E, Benjamin A. Epilepsy and pregnancy: an obstetric perspective. Am j obstet gynecol. 2004 Feb 1;190(2):371-9. https://doi.org/10.1016/j.ajog.2003.09.020PMid:14981376 Moatti Z, Gupta M, Yadava R, Thamban S. A review of stroke and pregnancy: incidence, management and prevention. Eur J Obstet Gynecol Reprod Biol. 2014 Oct 1;181:20-7. https://doi.org/10.1016/j.ejogrb.2014.07.024PMid:25124706 Haghighi AB, Ashjazadeh N, Safari A, Cruz-Flores S. Cerebral venous sinus thrombosis in iran: cumulative data, shortcomings and future directions. IRCMJ 2012 Dec;14(12):805. https://doi.org/10.5812/ircmj.3728PMid:23483618 PMCid:PMC3587871 Siroos B, Harirchian MH. Multiple sclerosis and pregnancy; What a neurologist may be asked for?. Iran J neurol. 2014 Apr 3;13(2):57. Sax TW, Rosenbaum RB. Neuromuscular disorders in pregnancy. Muscle & Nerve: Official Journal of the American Association of Electrodiagnostic Medicine. 2006 Nov;34(5):559-71. https://doi.org/10.1002/mus.20661PMid:16969835 Djelmis J, Sostarko M, Mayer D, Ivanisevic M. Myasthenia gravis in pregnancy: report on 69 cases. Eur J Obstet Gynecol Reprod Biol. 2002 Aug 5;104(1):21-5. https://doi.org/10.1016/S0301-2115(02)00051-9 Brooks H, Christian AS, May AE. Pregnancy, anaesthesia and Guillain Barre syndrome. Anaesthesia. 2000 Sep 26;55(9):894-8. https://doi.org/10.1046/j.1365-2044.2000.01367.xPMid:10947755 Wiertlewski S, Magot A, Drapier S, Malinovsky JM, Péréon Y. Worsening of neurologic symptoms after epidural anesthesia for labor in a Guillain-Barre patient. Anesthesia Analgesia. 2004 Mar 1;98(3):825-7. https://doi.org/10.1213/01.ANE.0000101985.38587.1BPMid:14980945 Roelvink NC, Kamphorst W, van Alphen HA, Rao BR. Pregnancy-related primary brain and spinal tumors. Arch neurol. 1987 Feb 1;44(2):209-15. https://doi.org/10.1001/archneur.1987.00520140069020PMid:3545159 Chaudhuri P, Wallenburg HC. Brain tumors and pregnancy: Presentation of a case and a review of the literature. Eur J Obstet Gynecol Reprod Biol. 1980 Oct 1;11(2):109-14. https://doi.org/10.1016/0028-2243(80)90016-7

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Published

2019-12-31

How to Cite

Borhani-Haghighi, A., Zafarmand, S., Javanmardi, H., Ameri, M., Maneshi, M., Mansouri-Mehrabadi, S., … Aramesh, A. (2019). Evaluation of the Neurological Complaints during Pregnancy and Postpartum: . Galen Medical Journal, 8, e1616. https://doi.org/10.31661/gmj.v8i.1616

Issue

Vol. 8 (2019): 2019

Section

Short Communication

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https://creativecommons.org/licenses/by/4.0/