NEUROLOGICAL DISORDERS AND PREGNANCY
Outline A WOMAN WITH MYASTHENIA GRAVIS
I A Woman with a Seizure Disorder
II A Woman with Myasthenia Gravis
III A Woman with Multiple Sclerosis
A WOMAN WITH A SEIZURE DISORDER
 Recurrent seizures have several causes, such as head
trauma or meningitis. The causes of most recurrent
seizures, however, are unknown (idiopathic).
THERAPEUTIC MANAGEMENT
o Women with recurrent seizures need to meet with their
obstetrician and primary care provider before
pregnancy to be certain the medications they are
taking are the least teratogenic ones possible and the
dosage they are taking is the lowest possible to control
seizures
o All women should have an evaluation of serum drug
levels before pregnancy or early in pregnancy to
establish that their medication is being prescribed at a
therapeutic level.
o As blood volume increases with pregnancy, some
women may need their dosage increased or their
serum level will be diluted.
COMMON DRUGS PRESCRIBED TO CONTROL
SEIZURES ARE:
o Trimethadione (Tridione) (pregnancy risk category D)
o Valproic acid (sodium valproate and divalproex
sodium) (pregnancy risk category D)
o Carbamazepine (Tegretol) (pregnancy risk category C)
o Ethosuximide (Zarontin), a drug often used to control
absence seizures (pregnancy risk category C)
o Phenytoin sodium (Dilantin) (pregnancy risk category
D)
 Absence seizures (often just a rapid fluttering of the
eyelids or a moment’s staring into space) should have no
effect on a woman or fetus
 Tonic-clonic seizures (sustained, full-body involvement)
could affect a fetus because spasm of the chest muscles
could lead to hypoxia
 is an autoimmune disorder characterized by the presence
of an IgG antibody against acetylcholine receptors in
striated muscle.
 This causes failure of the striated muscles to contract,
particularly those of the oropharyngeal, facial, and
extraocular groups.
 Myasthenia gravis is treated with anticholinesterase
drugs such as pyridostigmine (Mestinon) or neostigmine
(Prostigmin) and possibly a corticosteroid such as
prednisone. These medications may be continued during
pregnancy, as the fetus will experience no effects from
these drugs.
 Plasmapheresis (removal of and replacement of plasma)
to remove immune complexes from the bloodstream may
be prescribed to reduce symptoms.
 Magnesium sulfate should be avoided because it can
diminish the acetylcholine effect and therefore increase
disease symptoms.
 An infant born to a woman with myasthenia gravis may
demonstrate disease symptoms at birth because of the
transfer of antibodies.
A WOMAN WITH MULTIPLE SCLEROSIS
 Nerve fibers become demyelinated and therefore lose
function.
 Women develop symptoms of fatigue, numbness, blurred
vision, and loss of coordination
 ACTH or a corticosteroid is commonly given to strengthen
nerve conduction. These both can be administered safely
during pregnancy.
 In contrast, cyclosporine (Sandimmune), azathioprine
(Imuran), and cyclophosphamide (Cytoxan), drugs also
frequently administered, are not safe for use during
pregnancy.
 Women may continue with plasmapheresis (withdrawal and
replacement of plasma), another treatment regimen, during
pregnancy as long as the volume of exchange is well
controlled.
A.Y. 2022-2023 | BSN 2-B 1