January 16, 2024

Managing Neurological Disorders in Pregnancy (Podcast)

A discussion of special care considerations before, during and after pregnancy

Physiologic changes that occur during pregnancy can exacerbate symptoms of existing neurologic disorders and cause a host of acute neurologic issues.

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“There’s a fundamental principle of neuro-obstetrics,” says Caroline Just, MD, a neurologist in Cleveland Clinic’s Center for General Neurology who specializes in obstetric neurology. “We want to empower patients with the right information to make their own risk-benefit decisions. We don’t want to assume that the risks always outweigh the benefits.”

In the latest episode of Cleveland Clinic’s Neuro Pathways podcast, Dr. Just discusses management of neurologic disorders during pregnancy as well as considerations for the preconception and postpartum periods. She covers:

  • Medications that pregnant individuals should avoid if they have various neurologic conditions
  • The importance of monitoring drug dosing levels during pregnancy
  • The use of C-section delivery and epidurals in women with neurologic disease
  • Therapeutic interventions that may influence birth control efficacy
  • How neurologic disorders may be impacted during the postpartum period
  • The importance of collaboration among neurologists, obstetricians and maternal-fetal medicine specialists in the care of pregnant patients with neurologic disorders

Click the podcast player above to listen to the 27-minute episode now, or read on for a short edited excerpt. Check out more Neuro Pathways episodes at clevelandclinic.org/neuropodcast or wherever you get your podcasts.

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Excerpt from the podcast

Podcast host Glen Stevens, DO, PhD: What do clinicians need to consider when an individual with an existing disorder becomes, or wants to become, pregnant?

Dr. Just: One thing that’s really important to know is that certain medications can be teratogenic, and their half-life is really important to know leading up to preconception, particularly for some of the newer medicines. For instance, there are CGRP [calcitonin gene-related peptide] inhibitors for migraine that have very long half-lives, so it’s imperative that we clinicians tell our patients to give us notice if they are planning on having a child or trying to get pregnant. Of course, a large percentage of pregnancies are unplanned, so it’s important to have a conversation about the possibility of pregnancy for all patients of childbearing potential.

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Multiple sclerosis [MS] often calls for pregnancy-related considerations. Pregnancy definitely plays a role in MS treatment, and MS often plays a role in when people choose to get pregnant — whether they want to be off meds for longer if they are trying to conceive or if they’re considering fertility treatment. So pregnancy definitely plays a huge role there.

Another really important consideration arises with epilepsy. Many anti-seizure medicines are teratogenic, but many are only very slightly teratogenic while others are much more concerning. Knowing the difference between these degrees of teratogenicity is highly important. For example, there are very few scenarios in which a patient of childbearing potential should be taking valproate.

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