Can cervical dystonia worsen during pregnancy?

Question

Hi doctor,

I wanted to ask about a relative of mine, who is 32 years old and has been recently diagnosed with cervical dystonia. She has been trying to conceive for a few months now, and this diagnosis has shaken her. Her neck spasms have worsened lately, and she’s feeling very anxious about how this might affect her fertility or a potential pregnancy.

She is worried whether dystonia medications, especially botulinum toxin injections or oral anticholinergics, could harm her baby if she conceives.

Could her condition worsen during pregnancy or affect her ability to carry the baby safely? Her periods have also become irregular since starting treatment.

Thanks.

Answer 1

Hello,

Welcome to icliniq.com.

I can understand your concern.

Cervical dystonia does not directly affect fertility. However, chronic stress, pain, or sleep disturbances from dystonia can affect the menstrual cycle and ovulation. If her periods became irregular after starting treatment, that could point to a medication side effect or stress-related hormonal imbalance.

Some case reports of women receiving botulinum toxin during pregnancy (often for medical reasons) did not show clear harm to the baby, but large-scale safety data are lacking. So, most neurologists and obstetricians recommend avoiding Botox during pregnancy, especially in the first trimester, unless the benefits outweigh the risks.
Oral anticholinergics (e.g., Trihexyphenidyl, Benztropine) can cross the placenta and are also category C. Animal studies suggest potential risks like fetal growth restriction or developmental issues, though human data is sparse. Also, anticholinergics can sometimes affect lactation or cause urinary retention, which may complicate postpartum recovery. The course of dystonia during pregnancy is unpredictable:

Some women report no change; others experience worsening of symptoms due to hormonal shifts, physical stress, or stopping medication. Labor and delivery are generally not contraindicated with cervical dystonia, but positioning during delivery and pain management might need special planning (especially if neck spasms are severe).

Irregular periods may be due to:

1. Medication side effects (especially anticholinergics).

2. Stress and chronic pain.

3. Changes in body weight or hormone levels.

It may be helpful to check hormone levels such as LH (luteinizing hormone), FSH (follicle-stimulating hormone), prolactin, and TSH (thyroid-stimulating hormone) to rule out other causes of menstrual disturbance.

I hope this information will help you.

Thanks.