- Describe your topic.
- Our topic nomination is Neurologic Diseases in Pregnancy. The following is a list of clinical questions practitioners consider when managing such cases: a. For each disorder (Multiple Sclerosis, Epilepsy/Seizures, Myasthenia Gravis, Pseudotumor Cerebri/Idiopathic Intracranial Hypertension, Nerve compression (Sciatica/carpal tunnel)): i. What is the role for preconceptual counseling and/or prenatal discussion to weigh the risks and benefits of medication use (including maternal, fetal effects) vs. alternatives (tapering dosages, switching meds, or discontinuing meds)? ii. What are the potential disease complications during pregnancy? iii. What pregnancy complications are increased in the setting of this disorder? iv. What additional monitoring of maternal and fetal well-being is indicated? v. What changes in labor and delivery management are indicated? vi. What are the special considerations for postpartum period? vii. What are the short and long term implications for the neonate? The population of interest includes pregnant women with neurologic diseases, including Multiple Sclerosis, Epilepsy/Seizures, Myasthenia Gravis, Pseudotumor Cerebri/Idiopathic Intracranial Hypertension, Nerve compression (Sciatica/carpal tunnel) The interventions we would like to know more about include preconceptual counseling on medication use, alternatives to medication during pregnancy, labor and delivery changes, and postpartum considerations The outcomes include implications for the neonate and pregnancy complications
- Describe why this topic is important.
- There are a variety of neurological disorders with the potential to result in pregnancy complications and adverse outcomes for the pregnant woman and the neonate. It is important that clinicians have evidence based guidance on how to identify and treat these complications, and on what changes to their practice they must make in comparison to women without these disorders.
- Tell us why you are suggesting this topic.
- We are suggesting this topic because a review on this topic would provide clinicians in multiple disciplines with evidence based guidance on how to care for women with Multiple Sclerosis, Epilepsy/Seizures, Myasthenia Gravis, Pseudotumor Cerebri/Idiopathic Intracranial Hypertension, Nerve compression (Sciatica/carpal tunnel). This will improve health outcomes for both pregnant women and neonates
- Target Date.
- Describe what you are doing currently and what you are hoping will change because of a new evidence report.
- ACOG is currently working on clinical guidance in the form of a Practice Bulletin on Neurologic Diseases in Pregnancy. We already have guidance in the form of Committee Opinions on “Obstetric Management of Patients with Spinal Cord Injuries”. We hope that a new evidence report will provide more definitive information on complications resulting from and monitoring and management of pregnant women with neurologic diseases
- How will you or your group use the information from a new evidence report?
- A new evidence report on neurologic diseases in pregnancy will be used to develop future clinical guidance in the form of Practice Bulletins or Committee Opinions on this topic. Clinicians will then be better qualified to identify, make appropriate treatment decisions, and improve health outcomes for women with these diseases.
- How would you or your group plan to disseminate information from the report? Who would you plan to disseminate it to?
- ACOG will share the information in this report with its 57,000 members through our website, and will update our clinical guidance to be reflective of the findings from this report.
- Do you know of organizations that could use an evidence report to change clinical practice? Are you a part of, or have you been in contact with, any organizations that might implement the research findings of an evidence report?
- 1American Academy of Neurology, American Epilepsy Society, American Neurological Association, Society for Academic Specialists in General Obstetrics and Gynecology, Society for Maternal-Fetal Medicine
- Information About You: (optional)
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- Provide a description of your role or perspective.
- Professional society
- If you are you making a suggestion on behalf of an organization, please state the name of the organization.
- The American College of Obstetricians and Gynecologists
- Please tell us how you heard about the Effective Health Care Program.
- AHRQ Alert/Correspondence
