Neurological disease in pregnancy

Neurological disease encompasses a broad spectrum of conditions which may be affected by pregnancy, present de novo in pregnancy, or are caused by the pregnancy itself. In the Confidential Enquiry into Maternal Deaths Report 2006–08, 36 women died from diseases of the central nervous system, and 11 of these women were deemed to have had major substandard care. The overall number of deaths is similar to that of previous years, and the proportion with epilepsy was unchanged. Pre-pregnancy counselling should be offered to patients in order to optimise their condition, as well as to make appropriate changes to medication. A thorough history and physical examination should be performed, and specialist advice sought early when looking after these women in their pregnancies. Women should be managed by a multidisciplinary team, ideally including a neurologist, specialist nurse or midwife, obstetrician with an interest in maternal medicine, obstetric physician and an obstetric anaesthetist.