Multidisciplinary management of idiopathic intracranial hypertension in pregnancy: case series and narrative review

Alves, Sara; Sousa, Natacha; Cardoso, Luisa Kecyane Batista; Alves, Joana

doi:10.1016/j.bjane.2021.02.030

Cited by 8 publications

(10 citation statements)

References 30 publications

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“…These are not usually recommended for management of IIH,8 but our experience suggests that in pregnancy they can sometimes provide short-term treatment 60 61. It is useful to note that in a commonly cited pregnancy publication, single lumbar punctures (LPs) were only needed in 25% (3/12) 60.…”

Section: During Pregnancymentioning

confidence: 99%

Managing idiopathic intracranial hypertension in pregnancy: practical advice

et al. 2022

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Idiopathic intracranial hypertension (IIH) is more common in women of reproductive age who have obesity, yet there is little information on its management specifically in pregnancy. Women with IIH should plan their pregnancy including discussing contraception before pregnancy, recognising that hormonal contraceptives are not contraindicated. Potentially teratogenic medications including acetazolamide and topiramate are not recommended during pregnancy or in those with immediate plans to conceive; prescribing acetazolamide in pregnancy must only follow discussion with the patient and their obstetrician. Ideally, patients should aim to achieve disease remission or control before pregnancy, through optimising their weight. Although weight gain is expected in pregnancy, excessive weight gain may exacerbate IIH and increase maternal and fetal complications; evidence-based recommendations for non-IIH pregnancies may help in guiding optimal gestational weight gain. The vast majority of women with IIH can have a normal vaginal delivery, with spinal or epidural anaesthesia if needed, provided the papilloedema is stable or the IIH is in remission.

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Section: During Pregnancymentioning

confidence: 99%

Managing idiopathic intracranial hypertension in pregnancy: practical advice

et al. 2022

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“…Although the literature is sparse regarding the management of IIH in pregnancy, several studies have made suggestions on how to best manage this patient population [4][5][6]11]. The literature has determined that therapeutic abortion is not indicated in this patient population, and the evidence from this study agrees [4,5,7,9,15].…”

Section: Discussionmentioning

confidence: 58%

“…IIH often affects women of childbearing age [4][5][6][7][8][9][10]. Of those with IIH, pregnancy has a reported prevalence of 2-12% [4,7,11].…”

Section: Introductionmentioning

confidence: 99%

“…Of those with IIH, pregnancy has a reported prevalence of 2-12% [4,7,11]. Pregnancy can act as a crucible for IIH as it is often associated with rapid weight gain, increased vasodilation, increased cardiac output, increased blood volume, increased sodium and water retention, increased central venous pressure, and increased Valsalva maneuvers during labor, which, in turn, increase intracranial pressure [4,6,11]. Thus, pregnancy is a unique and high-stakes time that demands careful and effective diagnostic and therapeutic action to best manage the safety of both the mother and the fetus.…”

Section: Introductionmentioning

confidence: 99%

“…Thus, pregnancy is a unique and high-stakes time that demands careful and effective diagnostic and therapeutic action to best manage the safety of both the mother and the fetus. Because current research is limited, and as there are no concrete guidelines to help physicians determine the treatment of IIH in pregnancy, it is necessary to understand associations between pregnancy and IIH [4][5][6]11]. This study seeks to determine if there is a correlation between IIH and pregnancy complications such as ectopic or molar pregnancy, cesarean section, abortion, preterm labor, depression, pre-eclampsia/eclampsia, and mortality to elucidate if pregnancy is safe for individuals with IIH.…”

Section: Introductionmentioning

confidence: 99%

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Pregnancy and Childbirth in Women With Idiopathic Intracranial Hypertension

Hallan¹,

Lin²,

Tankam³

et al. 2022

Cureus

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BackgroundIdiopathic intracranial hypertension affects many women of childbearing age. However, the literature is sparse regarding pregnancy outcomes for these women. The goal of this study is to investigate the relationship between pregnancy outcomes in patients with a diagnosis of idiopathic intracranial hypertension. MethodologyThe TriNetX Research Network database was used to query 57 healthcare organizations for patients with idiopathic intracranial hypertension while pregnant (cohort 1) versus those who were pregnant without idiopathic intracranial hypertension (cohort 2). Cohorts were propensity-score matched for confounders related to pregnancy outcomes. The primary outcomes of interest were ectopic or molar pregnancy, cesarean section, abortion, preterm labor, depression, pre-eclampsia or eclampsia, and mortality. Chi-square analysis and logistic analysis were used on categorical variables. ResultsEctopic/molar pregnancy was seen in 106 (1.75%) versus 117 (1.93%) (odds ratio (OR) 0.904, 95% confidence interval (CI) (0.694, 1.179), p = 0.4572) patients in cohorts 1 and 2, respectively. Cesarean section was seen in 785 (12.94%) versus 886 (14.59%) (OR 0.869, 95% CI (0.784, 0.964), p = 0.0078) patients, abortion in 536 (8.83%) versus 682 (11.24%) (OR 0.765, 95% CI (0.679, 0.862), p < 0.0001), preterm labor in 498 (8.206%) versus 668 (11.01%) (OR 0.723, 95% CI (0.640, 0.816), p < 0.0001), depression in 1,057 (17.42%) versus 1,061 (17.48%) (OR 0.995, 95% CI (0.906, 1.093), p = 0.9238), and pre-eclampsia/eclampsia in 501 (8.26%) versus 492 (8.11%) (OR 0.1.02, 95% CI (0.896, 1.161), p = 0.7657). Mortality was seen in 68 patients in cohort 1 versus 13 patients in cohort 2 (OR 5.279, 95% CI (2.913, 9.564), p < 0.0001). ConclusionsThis retrospective study examined pregnancy outcomes for pregnant women with a diagnosis of idiopathic intracranial hypertension. Women with idiopathic intracranial hypertension do not have an increase in rates of abortion, ectopic/molar pregnancy, cesarean section, preterm labor, or depression when compared to women without idiopathic intracranial hypertension. The mortality rate was higher in the idiopathic intracranial hypertension cohort, but still very low. This study demonstrates that pregnancy is generally well tolerated in the idiopathic intracranial hypertension population.

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Neuraxial Techniques in Obstetric Patients with Intracranial Lesions

Clark

Chau

2023

Curr Obstet Gynecol Rep

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Multidisciplinary management of idiopathic intracranial hypertension in pregnancy: case series and narrative review

Cited by 8 publications

References 30 publications

Managing idiopathic intracranial hypertension in pregnancy: practical advice

Managing idiopathic intracranial hypertension in pregnancy: practical advice

Pregnancy and Childbirth in Women With Idiopathic Intracranial Hypertension

Neuraxial Techniques in Obstetric Patients with Intracranial Lesions

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