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Neurological diseases in pregnancy

Toscano, Marika; Thornburg, Loralei L.

Current Opinion in Obstetrics and Gynecology: April 2019 - Volume 31 - Issue 2 - p 97–109
doi: 10.1097/GCO.0000000000000525
MATERNAL FETAL MEDICINE: Edited by Deirdre Lyell, Mark Boddy, and Martha Rode
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Purpose of review To summarize recent research findings and current concepts related to care of neurologic diseases in pregnancy and the risks of pregnancy to the mother–infant dyad. Recent publications related to best practices for neurologic care, risks of pregnancy, rate of relapse during and after pregnancy, as well as medication safety in pregnancy and lactation for more commonly used neurologic medications are reviewed.

Recent findings Data continues to grow that women with neurologic conditions can experience pregnancy with minimal risks. Additionally, as more data is being published on medication safety in pregnancy and lactation, most medical therapy is now thought to be compatible, improving symptoms and care for women with neurologic conditions who require pharmacologic treatment. However, data remains limited from clinical trials and from more objective studies. Researchers continue to clarify the impact of pregnancy on the course of chronic neurologic diseases such as multiple sclerosis, myasthenia gravis, epilepsy, migraine, and cerebral aneurysms as well as the impact of these diseases on antepartum, labor and delivery, and postpartum management and neonatal course. Acute neurological conditions with pregnancy-associated risk such as stroke, posterior reversible encephalopathy syndrome, and cerebral venous sinus thrombosis are increasingly studied to determine individuals who are most vulnerable to these serious complications.

Summary Many neurological diseases coexist with pregnancy. Recent research indicates a good prognosis for both mother and neonate. Although research related to neurologic disease in pregnancy is growing, it remains an area that deserves further focus to guide evidence-based care. With advances in research on therapeutic options, some women can achieve a safe pregnancy in the setting of chronic neurological disease.

Video abstract http://links.lww.com/COOG/A45.

Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, New York, USA

Correspondence to Loralei L. Thornburg, MD, 601 Elmwood Ave, Box 668, Rochester, NY 14624, USA. Tel: +1 585 275 7480. E-mail: Loralei_thornburg@urmc.rochester.edu

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