Neurologic conditions including epilepsy and multiple sclerosis during pregnancy can pose unique challenges. Hormonal changes, increased blood volume, changes in sleep, and a higher risk of clotting during pregnancy can worsen pre-existing neurologic conditions and introduce new neurologic symptoms.
At Brigham and Women’s Hospital (BWH), we provide highly specialized care for women with neurologic conditions before, during, and after pregnancy. Our multidisciplinary team of experts, including maternal-fetal medicine (high-risk pregnancy) specialists, neurologists, neurosurgeons, neuroradiologists, anesthesiologists, and specialized nurses, is dedicated to delivering the highest level of care for both the mother and the baby.
Women with pre-existing neurologic conditions who are planning a pregnancy and women who develop neurologic symptoms during pregnancy require specialized care. In these cases, it is very important that a team of specialists in multiple disciplines – including maternal-fetal medicine, neurology, neurosurgery, and other specialties – be closely involved in the care of both the mother and the baby.
For women with pre-existing neurologic conditions, planning with the medical team should begin before conception in order to understand how to best manage conditions during pregnancy. Nutritional supplementation and adjustments in medication are often recommended prior to conception to help decrease the risks to the baby during pregnancy. The mother should not reduce or discontinue medications on her own.
A detailed prenatal care plan is developed to address the mother’s individual health issues. Ideally, medication adjustments and planning are started before or early in the pregnancy. The mother’s neurologic symptoms and the baby’s growth and development need to be carefully monitored by the team throughout pregnancy.
Epilepsy and other seizure disorders are among the more common neurologic conditions seen in pregnancy. Seizures during pregnancy present risks to both the mother and the baby, with decreased oxygenation and increased risks of injury from falls or other accidents. Obtaining optimal control of seizure activity using the lowest medication doses required is critical.
In addition to the prenatal care team, obstetric anesthesiologists are a key part of the delivery process. While women with epilepsy and other neurologic conditions may be eligible for natural childbirth, a delivery plan developed by the multidisciplinary medical team should anticipate possible urgencies that may occur during delivery. Neurologic symptoms, such as seizures, flares related to multiple sclerosis (MS), and migraines, may increase after delivery. Postpartum care should be coordinated with the providers for the mother and baby after delivery and discharge from the hospital. Mothers with epilepsy and other seizure disorders also should be counseled on guidelines to use when caring for their babies, such as bathing and changing the baby, to ensure safety in the event of a seizure.
Experts in maternal-fetal medicine at Brigham and Women’s Hospital collaborate closely with specialists in the Women’s Neurology Program at Brigham and Women’s Hospital to provide seamless care for women with neurologic conditions before, during, and after pregnancy. The Women’s Neurology Program is a unique interdisciplinary and interdivisional neurology program that brings together neurologists, neuroradiologists, neurosurgeons, and a wide range of other specialists with a clinical and research interest in women’s health. Developed through a collaboration between the Connors Center for Women's Health and Gender Biology, and the Department of Neurology, the Women’s Neurology Program is designed to meet the unique health care needs of women suffering from neurological disease.
The Women’s Neurology Program focuses on gender differences in medical evaluation, diagnosis, implementation of treatment and care. The team considers how hormonal and reproductive changes throughout a woman's lifespan, including pregnancy and menopause, as well as use of oral contraceptives and assisted reproduction, impact neurological health and disease. Under the leadership of its current Director, M. Angela O'Neal, MD, the Program is raising awareness of issues specific to women with neurological disease and building research collaborations that examine gender differences in neurological disease.
To schedule an appointment or to learn more about our services, please contact us at (617) 732-4840.
Brigham and Women’s Hospital
75 Francis Street
Boston, MA 02115
Thomas F. McElrath, MD, PhD
Division of Maternal-Fetal Medicine
Page B. Pennell, MD
Department of Neurology
M. Angela O’Neal, MD
Department of Neurology
Specialties: General Neurologic Conditions, Headache
Maria Houtchens, MD
Department of Neurology
Specialty: Multiple Sclerosis
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