NEUROLOGICAL DISEASES IN PREGNANCY: CLINICAL PROFILE, ETIOLOGY, AND FETO-MATERNAL OUTCOME

Abstract

Background: Pregnancy modifies the presentation and course of neurological disease, and neurological illness in turn affects maternal and fetal wellbeing. Data on this interaction from the Indian subcontinent remain limited.

Objectives: To study the clinical presentation, etiology, and maternal and fetal outcomes of neurological disease complicating pregnancy and the puerperium.

Methods: This prospective observational study was conducted at a tertiary care centre from November 2022 to May 2024. Sixty pregnant or puerperal women with neurological symptoms or signs were enrolled after informed consent. Patients with classical pre-eclampsia/eclampsia without focal neurodeficit, non-organic neurological complaints, and hepatic or uremic encephalopathy were excluded. Detailed clinical evaluation, laboratory work-up, neuroimaging, and electrophysiological testing were performed as indicated, and patients were followed for 42 days postpartum. Associations were tested using the chi-square or Fisher's exact test, with p<0.05 considered significant.

Results: The mean age was 23.8 years; 62% were primigravida and 62% presented postnatally. The commonest presenting features were headache (83%), seizures (73%) and altered sensorium (65%). Posterior reversible encephalopathy syndrome (PRES) was the leading diagnosis (36.7%), followed by cerebral venous sinus thrombosis (CVST, 33.3%); arterial stroke, epilepsy and CNS infections accounted for the remainder. PRES was significantly associated with primigravida status (77%, p=0.049), antenatal presentation (p=0.049), and pregnancy-induced hypertension (77%, p<0.001), and required more frequent preterm delivery (55%, p=0.033) and caesarean section (55%, p=0.033); neurological recovery was excellent (95.5% full recovery, p=0.012) but fetal morbidity was high (68% low birth weight). CVST occurred with equal frequency in primigravida and multigravida, was significantly more common postpartum (90%, p=0.002), and showed no association with pregnancy-induced hypertension. Overall maternal mortality was 11.7% and fetal loss was 20%; low birth weight affected 50% of surviving infants.

Conclusion: PRES and CVST together account for the majority of pregnancy-associated neurological disease in this population, each with a distinct clinico-demographic signature. Early recognition — guided by presenting symptoms, timing relative to delivery, and blood pressure status — allows timely imaging and intervention, improving maternal recovery, though fetal morbidity remains substantial.