Pregnancy and neurologic complications of COVID‐19: A scoping review

Abstract

While neurologic complications are frequently reported among patients with COVID‐19 in the general population, they are unknown in pregnant women. This paper summarizes the case reports of pregnant women with confirmed SARS‐CoV‐2 infection plus a specified neurologic diagnosis. Until November 2021, 18 case reports were found. Both the central and peripheral nervous systems were equally affected: delirium ( n = 1), posterior reversible encephalopathy syndrome ( n = 4), cerebrovascular disease ( n = 2), acute cerebral demyelinating disease ( n = 1), acute necrotizing encephalopathy ( n = 1), Guillain–Barré syndrome ( n = 5), including one patient who also had vestibular neuritis, Bell's palsy ( n = 3), and rhabdomyolysis ( n = 1). The median maternal age was 32.5 (25—35) years, the median gestational age was 34 (30—36.5) weeks, and 38.9% presented previous medical conditions. Respiratory symptoms were reported in 76.5%, and 76.5% received immunotherapies to treat the COVID‐19 or the neurologic complications. Half the women required admission to ICU and, more often, were those with central nervous system involvement (77.8% vs. 22.2%; Chi‐square test, p = .018). For 64.7% of women, the most common method of delivery was surgical, although just one case was due to the neurologic complication. There were reports of one spontaneous abortion, two fetal deaths, and no maternal deaths. Only one case presented a poor neurologic outcome. It is possible that our findings are underestimated, considering that there are thousands of reports regarding neurologic complications in the general population with COVID‐19.

Reply: Neurological disease in pregnant females with COVID ‐19 may not only be attributable to SARS‐CoV ‐2

“…Therefore, we have herein revised 10 patients with central nervous system (CNS) involvement (48%) and 11 patients with peripheral nervous system (PNS) involvement (52%) in order to compare with our previous results. 2 Updated results have demonstrated that the median maternal age remained 32 (27.5-34.5) years, and the median gestational age was reduced to 32 (28-36) weeks. Interestingly, the woman who had suffered a stroke was in the 7th week of gestation.…”

“…The peer review history for this article is available at https://publo ns.com/publo n/10.1111/ane.13663. João Eudes Magalhães 1,2 Pedro Augusto Sampaio-Rocha-Filho…”

“…We appreciate the interest and observations of Professor Finsterer 1 regarding our recently published review article. 2 The other three pregnant women with COVID‐19 and neurological complications, 3 , 4 , 5 which he identified, were not included in our original article, even though we had been careful during the search process using broad terms in several combinations as described in the Methods section. 2 He summarized 1 a new stroke case 5 and two new cases of Guillain‐Barré syndrome (GBS) 3 , 4 in pregnant women with COVID‐19.…”

“… 2 The other three pregnant women with COVID‐19 and neurological complications, 3 , 4 , 5 which he identified, were not included in our original article, even though we had been careful during the search process using broad terms in several combinations as described in the Methods section. 2 He summarized 1 a new stroke case 5 and two new cases of Guillain‐Barré syndrome (GBS) 3 , 4 in pregnant women with COVID‐19. Therefore, we have herein revised 10 patients with central nervous system (CNS) involvement (48%) and 11 patients with peripheral nervous system (PNS) involvement (52%) in order to compare with our previous results.…”

Neurological disease in pregnant females with COVID ‐19 may not only be attributable to SARS‐CoV ‐2

“…stroke (n = 1), venous sinus thrombosis (VST) (n = 1), acute disseminated encephalomyelitis (ADEM) (n = 1), and acute necrotizing encephalopathy (n = 1). 1 Peripheral nervous system disease diagnosed in this cohort included Guillain Barre syndrome (GBS) (n = 5), Bell's palsy (n = 3), and rhabdomyolysis (n = 1). 1 The study is appealing but has limitations that raise concerns that need to be discussed.…”