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.
Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy
“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:
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.
This activity has been approved for AMA PRA Category 1 Credit™ and ANCC contact hours. After listening to the podcast, you can claim your credit here.
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.
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.
Determining the right dose and injecting in the right muscle can be challenging
New research sheds light on a potentially devastating condition that is reversible when properly managed
Testing options and therapies are expanding for this poorly understood sleep disorder
Neurology is especially well positioned for opportunities to enhance clinical care and medical training
How functional restoration can help children with these conditions marked by unexplained pain with stigmatized symptoms
Despite advancements, care for this rare autoimmune disease is too complex to go it alone
Data-driven methods may improve seizure localization and refine surgical decision-making
When and how a multidisciplinary palliative care clinic can fill unmet needs for this population