Introduction
The pregnant state can affect many neurological diseases, while certain neurologic diseases or treatments significantly negatively affect pregnancy, labor, or delivery. Some conditions are unique to a pregnancy and postpartum states, such as eclampsia (high blood pressure during pregnancy, which occurs after pre-eclampsia) and delivery-associated neuropathies. Many neurological diseases can lead to devastating complications if not recognized early. Some conditions like preeclampsia (high blood pressure 20 weeks after pregnancy) are recognized by obstetricians and managed without significant neurological input unless seizures develop. Hypertension is one of the common medical pregnancy complications and contributes significantly to maternal and perinatal morbidity and mortality. The hypertensive disorders that cause neurological problems during pregnancy are, pre-eclampsia, eclampsia, and gestational hypertension.
What Are the Objectives of Early Diagnosis Complications of Pregnancy?
The following are the objectives of the diagnosis of early pregnancy:
-
Understanding the complications of hypertension during pregnancy.
-
Predictions and prevention of these complications.
-
Early identification and appropriate management.
-
Problem-based learning.
What Are the Neurological Problems That Are Common in Pregnancy?
The most common neurological problems during pregnancy are:
-
Migraine.
-
Eclampsia.
-
Preeclampsia.
-
Epilepsy.
-
Myasthenia gravis.
How Is Pregnancy Affected by Epilepsy?
It is a neurological disorder that involves recurrent seizures. It is difficult to predict how pregnancy affects epilepsy. However, some may experience frequent seizures while they are pregnant. The reason is that the medications used to treat epilepsy may work differently during pregnancy or may not be absorbed well. The physical and emotional stress that comes with pregnancy is also considered a potent trigger. On the other hand, epilepsy poses certain risks to pregnancy. Besides the general complications of the condition, the medications used to treat it can also adversely affect the mother, the unborn baby, and the pregnancy. Since women are more delicate while pregnant, having a seizure disorder heightens the risk of injuries and complications. Meanwhile, the type of medications may have serious side effects on the baby, such as abnormalities to the heart, slightly smaller size, congenital disabilities (for example, 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 labor, and miscarriages.
Pregnant women with epilepsy need close monitoring of the disease and fetal health, so more frequent prenatal visits are needed. Most women will be prescribed anticonvulsant medications. Proper monitoring also ensures that seizures 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 need to increase the folic acid dosage in pregnant women with epilepsy. This prenatal vitamin is routinely prescribed to all pregnant women to reduce the risk of babies defecting 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.
Why Do Pregnant Women Get Migraines?
The surge of hormones and increased blood volume often result in frequent headaches in pregnant women. Tension headaches are very common in pregnancy that causes mild to moderate pressing pain on both sides of the head. It resolves within a few minutes or hours or lasts several days. Migraines are not typical headaches. Migraine is a unilateral and often throbbing pain associated with nausea and sensitivity to light, sound, head movement, blurred vision, numbness, light flashes, or tingling on the face, arms, or leg. Migraine headache is a significant health problem affecting women more than men. The hormonal fluctuations during pregnancy and lactation affect the frequency and magnitude of migraines. Migraine attacks often increase in frequency in the first trimester but can be expected to decrease later in pregnancy. The attacks are less frequent in the second and third trimesters. The causes of migraine during pregnancy include:
-
Lack of sleep.
-
Low blood sugar.
-
Dehydration.
-
Stress.
-
The surge of hormones.
-
Increase in blood volume.
Headaches during the third trimester are related to poor posture and tension due to extra weight and conditions like preeclampsia. The aggravating factors of headaches include- stress, lack of sleep, nausea, vomiting, dehydration, sinus congestion, or nasal stuffiness. Pregnancy-induced hypertension, poor nutrition, low blood sugar levels.
What Are Eclampsia and Its Health Impact During Pregnancy?
Eclampsia is an acute and life-threatening complication during pregnancy, usually in patients with preeclampsia, characterized by hypertension, edema (accumulation of excess fluid in the body), protein in urine involving convulsions, and coma is called eclampsia.
The types of eclampsia include:
-
Antepartum 50 %.
-
Intrapartum 30 %.
-
Postpartum 20 % usually within 48 hours.
What Is the Pathophysiology of Eclampsia?
The pathophysiology of eclampsia is as follows:
-
Preeclampsia is called eclampsia when complicated with generalized tonic-clonic convulsions and coma.
-
It is considered a complication of preeclampsia.
-
These seizures can cause confusion and disorientation or lead to coma. In some cases, it can lead to stroke or death.
-
Preeclampsia can also become serious, affecting the patient's brain function and causing seizures or coma. In this condition, the blood pressure exceeds 160 by 110 mmHg (millimeters of mercury).
-
The protein in the urine is because of portal hypertension (high pressure in the kidney blood vessels) or sometimes kidney failure.
-
Because of edema and proteinuria, there is increased blood pressure (hypertension).
-
Hypertension leads to the poor blood supply to the brain. The brain cells are deprived of proper oxygen supply, which disturbs the brain's normal functions.
-
High blood pressure causes pressure on the blood vessels. There can be swelling in the brain, which may lead to seizures. The brain produces excessive electrical impulses or stimuli called a seizure.
What Are the Symptoms of Eclampsia?
The symptoms include:
-
Seizures.
-
Severe distress or confusion.
-
Losing consciousness.
-
Severe general edema.
-
Hypertension.
-
Intracranial hemorrhage is rare. Yet potentially devastating event in pregnancy. There is a risk of maternal mortality or morbidity and a significant risk to the unborn child. The risk of bleeding increases during the third trimester and is greatest during parturition and the puerperium.
Complications of Hypertension During Pregnancy
The fetal complications due to hypertension are:
-
Intrapartum fetal diseases.
-
Preterm delivery.
-
Placental abruption.
-
Increases the risk of cesarean section.
-
Hypoxic neurological injury.
-
Premature labor.
-
Stillbirth.
Acute complications of hypertension during pregnancy include:
-
Central nervous system complications, including eclampsia.
-
Acute respiratory failure.
What Are Preeclampsia and Its Neurological Impacts on Pregnant Women?
Preeclampsia is a condition in pregnant women characterized by high blood pressure levels, high protein release in the urine (proteinuria), and swelling in the feet, legs, and hands. It is one of the main causes of maternal death in the United States. Preeclampsia is sometimes referred to as toxemia.
-
The condition is characterized by elevated blood pressure midway through pregnancy, usually after 20 weeks. It may occur earlier as well but most commonly occurs in late pregnancy. Women with normal blood pressure experience a sudden spike in blood pressure when they are 20 weeks or more than 20 weeks pregnant. Women with diabetes or obesity are at higher risk of developing preeclampsia. In the United States, African women are at higher risk of developing this condition than Caucasian women. It also affects the lower socio-economic populations more.
-
The diagnostic criteria for preeclampsia are proteinuria, edema, and hypertension.
-
Pregnant women experience elevated blood pressure (equal to or exceeding 140 by 90 mmHg).
-
It can occur regardless of the previous history of high blood pressure or preeclampsia.
-
High blood pressure decreases the blood supply to the baby, which may cause less oxygen and nutrients. It affects the placenta, impairs liver function, and causes lung fluid accumulation. Premature babies are at risk for complications like low birth weight and respiratory problems.
-
The comparatively milder form of this condition is gestational hypertension, which may develop into preeclampsia.
-
The symptoms of eclampsia last for 6 to 12 weeks after delivery and resolve independently.
-
In mild preeclampsia, the diastolic blood pressure is above 90 mmHg but less than 110 mmHg and the systolic blood pressure is 140 mmHg. The mean arterial blood pressure exceeds 105 mmHg.
-
In severe preeclampsia, the systolic blood pressure is more than 160 mmHg, or diastolic blood pressure is more than 110 mmHg.
-
Proteinuria exceeds five grams per 24 hours.
How Does Multiple Sclerosis Affect Pregnancy?
Multiple sclerosis is a disorder that leads to problems in the central nervous system, the brain, and the spinal cord; in this disease, the body attacks the myelin sheath, an outer coating that protects the nerve cells. It is an autoimmune condition. When it gets damaged, the flow of information between the 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. Having multiple sclerosis does not seem to affect getting pregnant, nor does pregnancy speed up the course or worsen the effect of multiple sclerosis. The nine months of pregnancy are generally associated with fewer relapses. Those with unrecognized multiple sclerosis before getting pregnant are more likely to start experiencing symptoms during pregnancy. However, within three to six months after delivery, the symptoms tend to flare up again. Due to debilitating symptoms, it may be physically challenging for the patients to carry a pregnancy. It increases the likelihood of injuries due to muscle weakness and coordination problems. Furthermore, delivery becomes difficult as the muscles and nerves needed for pushing are also affected. This is why these patients usually undergo a C-section (Caesarean section), vacuum, or forceps delivery.
How Does Myasthenia Gravis Affect Pregnancy?
Myasthenia gravis (MG) is another autoimmune disorder that causes weakness in the skeletal muscles of the face and extremities. It worsens after periods of activity and improves after periods of rest. It usually affects women in their 20s and 30s or during childbearing.
Myasthenia gravis tends to worsen during the first trimester and postpartum period. The course of the disease varies, and pregnant women risk getting worse, respiratory failure, adverse drug reactions, a myasthenic crisis, and even death. Pregnancy does not appear to worsen the long-term effects of myasthenia gravis on women. Vaginal delivery is safe, and it should be encouraged. A C-section is carried out only when needed because surgery is associated with the worsening of myasthenia gravis and might even result in a myasthenic crisis. Since the uterine muscles are composed of smooth muscles, their ability to contract is not compromised with myasthenia gravis. Therefore, the first stage of labor is not affected. But as the woman progresses to the second stage of labor, she will need the striated muscles to work. This can be exhausting, and it often requires forceps or vacuum extraction.
Conclusion:
Neurologic disorders may come with symptoms that can make pregnancy more challenging, even to the point of being risky. However, it does not mean that having these conditions can rob a woman of bearing a child. Preparation, precaution, and close monitoring make it possible to have a safe pregnancy.
