Physiological changes during pregnancy increase the risk of developing certain neurological diseases.

More than 35 years have passed since May 28 was announced International Day of Action for Women’s Health focus on women’s reproductive health and health complications that may arise during pregnancy, childbirth and the postpartum period.

On the occasion of this anniversary Spanish Society of Neurology (SEN) took the opportunity to recall, as already explained in her textbook Neurology and Women, the need to early identify possible risks and take measures to protect women’s health.

“During pregnancy, a number of physiological changes occur, which, in combination with the pathological processes typical during this period, make women more predisposed to suffer from certain neurological diseases. And, perhaps, the most destructive disease that can have the most devastating consequences is stroke,” the doctor explained. Susana AriasMember of the Spanish Society of Neurology (SEN).

In the same vein, he added that “pregnant and postpartum women have increased risk of ischemic strokehemorrhagic or cerebral venous thrombosis, since the incidence of stroke during pregnancy and the puerperium is approximately three times higher than the incidence of stroke in non-pregnant women of the same age.

Ictus

Cerebral venous thrombosis, occurring during pregnancy and the postpartum period, accounts for 15-20% of the total number of annual cases, but, in addition, use of hormonal contraceptives

This is a major risk factor in young women. On the other hand, in pregnant women, hemorrhagic strokes account for 50% of stroke cases, in contrast to the general population, where they account for only 15% of cases.

Similarly, for every 100,000 pregnancies, there are 35 cases of ischemic strokes, and there is evidence to suggest that this incidence is increasing due to delay in maternity age and rising rates of obesity among pregnant women. The periods of greatest risk are the third trimester and the postpartum period up to 12 weeks.

“The most important risk factors for gestational stroke are smoking, a history of migraine, cardiomyopathy, primary hypercoagulable states, age (especially over 35 years) and pregnancy complications such as gestational hypertension and postpartum hemorrhage, blood transfusions and infections during childbirth. ; and assisted reproductive technologies and cesarean sections are also associated with an increased incidence of stroke,” Dr. Arias emphasized.

Moreover, he also noted that ” gestational hypertensionwhich affects one in 10 pregnant women, predisposes them to early development of any type of vascular disease, and some studies even say that this risk persists up to 17 years after birth.

Multiple sclerosis

Multiple sclerosis is predominantly a female disease, since for every man it is diagnosed in three women, especially those of childbearing age. And although this is a neurological disease does not have a negative effect on pregnancydoes not increase the risk of congenital malformations or abortions and there is no greater risk during childbirth, it also requires advance planning, since it is desirable for pregnancy to occur after a stable stage of the disease and because in addition, in many cases, conventional treatment will be discontinued.

“Although the protective effect of pregnancy on the occurrence of multiple sclerosis flares is known, due to the hormonal changes caused, these flares are also often worsened in the first months after birth, especially if the flares have occurred within a year. during or during pregnancy. We estimate that relapses occur in approximately 30-40% of patients during the first three months after birth. Therefore, it is important to properly plan with patients when it may be the right time for them to become mothers,” the doctor commented. Christina Iniguez

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“We must also take into account that in general use of disease-modifying drugs is not recommended during pregnancy and breastfeeding, which carries a risk of reactivation of the disease. In any case, there are already certain drugs that can be used during pregnancy according to clinical criteria. On the other hand, in patients with multiple sclerosis, the use of contraceptives should also be personalized,” he added.

Myasthenia gravis and migraine

Myasthenia gravis is also a disease that mainly affects young women, especially those between 20 and 40 years of age. They described both improvement and deterioration of the condition before and during menstruation, during pregnancy and in the postpartum period. In addition, myasthenia gravis during pregnancy also needs to be treated effectively, but with caution so as not to harm the fetus, therefore pregnancy must be plannedwith the disease in a stable situation.

In turn, migraine is one of the most common pathologies, especially in women of childbearing age, and for this reason it is a very common reason for seeking advice during pregnancy and the postpartum period. It’s not in vain twice as common in women than men and its evolution is influenced not only by menstruation, but also by menarche, pregnancy, menopause, and the use of contraceptive drugs or hormone replacement therapy.

And while overall most women experience significant improvement in the frequency and intensity of attacks during pregnancy, after childbirth a third worsen again during the first week of the postpartum period and more than 50% in the first month.

“In the case of pregnant women whose migraines do not improve during pregnancy, it is important to keep in mind that There are no clinical trials or regulated studies. about the use of migraine medications during pregnancy, as they constitute a population that is always excluded. Therefore, the decision to continue taking the medicine or not should always be made carefully and individually,” explained Dr. Susana Arias.

And Dr. Cristina Iñiguez, for her part, warned that “there are many neurological diseases that can debut or significantly worsen during pregnancy, childbirth and the postpartum period and can cause complications for the health of the woman, as well as for the health of the fetus.” “