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FP Essent 2019 Feb;477:22-28

University of South Alabama College of Medicine Department of Family Medicine, 1601 Center Street, 2N Mobile, AL 36604.

Family physicians may be the first point of contact for adults with new-onset seizure. There are many etiologies of seizures in adults. Etiologies of provoked seizures include temporary metabolic disturbances, central nervous system infections, cerebrovascular disease, drug withdrawal, and traumatic brain injury. Read More

Case Rep Womens Health 2019 Jan 23;21:e00097. Epub 2019 Jan 23.

University of South Alabama, Children's and Women's Hospital, Department of Obstetrics and Gynecology, 251 Cox Street, Mobile, AL 36604, United States.

Cerebrovascular disease is not uncommon during pregnancy as a result of either venous or arterial occlusion, or a hemorrhagic event, resulting in ischemia. Pregnancy may alter the prognosis of these neurologic disorders, with increased risks of morbidity and mortality for the mother and the developing fetus. Etiologies of stroke during pregnancy and the postpartum period include preeclampsia, eclampsia, HELLP syndrome, posterior reversible encephalopathy syndrome (PRES), amniotic fluid embolism, postpartum angiopathy, postpartum cardiomyopathy, thrombotic thrombocytopenic purpura (TTP), hemolytic uremic syndrome (HUS), cerebral venous thrombosis, CNS infections, and maternal thrombophilia. Read More

Curr Opin Obstet Gynecol 2019 Feb 5. Epub 2019 Feb 5.

Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, New York, USA.

Purpose Of Review: To summarize recent research findings and current concepts related to care of neurologic diseases in pregnancy and the risks of pregnancy to the mother-infant dyad. Recent publications related to best practices for neurologic care, risks of pregnancy, rate of relapse during and after pregnancy, as well as medication safety in pregnancy and lactation for more commonly used neurologic medications are reviewed.

Recent Findings: Data continues to grow that women with neurologic conditions can experience pregnancy with minimal risks. Read More

Obstet Med 2018 Dec 16;11(4):171-177. Epub 2018 Apr 16.

General Internal and Obstetrical Medicine, Department of Medicine, Hamilton Health Sciences Center, McMaster University, Hamilton, Canada.

Background: Devic syndrome or neuromyelitis optica is an autoimmune neurological condition characterized by relapsing symptoms of optic neuritis and transverse myelitis. Women with neuromyelitis optica suffer from adverse pregnancy outcomes and high relapse rates during pregnancy and the postpartum period.

Methods: This case series describes 13 pregnancies in four women with neuromyelitis optica managed at a tertiary hospital in Toronto, Canada. Read More

J Virol 2019 Mar 19;93(5). Epub 2019 Feb 19.

Human Vaccine Institute, Duke University Medical Center, Durham, North Carolina, USA

Human cytomegalovirus (HCMV) is the most common congenital infection worldwide and a frequent cause of hearing loss and debilitating neurologic disease in newborn infants. Thus, a vaccine to prevent HCMV-associated congenital disease is a public health priority. One potential strategy is vaccination of women of child bearing age to prevent maternal HCMV acquisition during pregnancy. Read More

Neurol Clin 2019 Feb;37(1):53-62

Department of Neurology, Mount Sinai Downtown, 10 Union Square East Suite 5D, New York, NY 10003, USA.

Epilepsy is a prevalent, chronic, and serious neurologic disease affecting many women of childbearing age. Specific concerns, including contraception, fertility, teratogenic risk of antiepileptic drugs, delivery, and breastfeeding, are addressed in this article. Evidence-based counseling and management strategies are provided to help clinicians and women with epilepsy through the different stages of pregnancy. Read More

Neurol Clin 2019 Feb;37(1):121-129

Department of Neurology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA; Department of Neurology, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.

Connective tissue disorders are now understood to include autoimmune and genetic diseases affecting organs, blood vessels, and surrounding fascia. Many of these diseases predominantly affect women in childbearing years and are associated with neurologic complications. Pregnancy can affect disease activity (such as flares of systemic lupus erythematosus), and the diseases can affect pregnancy outcome (such as increased risk of preterm labor). Read More

Rev Esp Salud Publica 2018 Nov 15;92. Epub 2018 Nov 15.

Centro de Coordinación de Alertas y Emergencias Sanitarias. Ministerio de Sanidad, Consumo y Bienestar Social. Madrid. España.

By mid-2015, an increase in the number of cases of microcephaly among newborns and neurologic disorders was detected in the Northwest of Brazil, which was possibly associated with Zika virus infection. Later on, this phenomenon was also observed in several Latin-American countries. In February 2016, the World Health Organization (WHO) on this basis, declared a Public Health Emergency of International Concern. Read More

Neurology 2018 Oct 28;91(17):e1559-e1569. Epub 2018 Sep 28.

From the Partners MS Center (M.K.H.), Brigham and Women's Hospital, Harvard Medical School, Boston; Health Services Consulting Corporation (N.C.E.), Boxborough; formerly with Boston Health Economics, Inc. (G.S.), Waltham; Boston Health Economics (K.S.), Waltham; and EMD Serono, Inc. (A.L.P.), Rockland, MA.

Objective: To compare pregnancy prevalence and complications in women with and without multiple sclerosis (MS).

Methods: This retrospective US administrative claims study used data from January 1, 2006, to June 30, 2015. All data for women with MS were included. Read More

Vasa 2018 10 12;47(6):451-464. Epub 2018 Sep 12.

1 Division of Angiology, East Bavarian Center of Vascular Medicine, University Hospital Regensburg, Regensburg, Germany.

Antiphospholipid syndrome (APS) is an autoantibody-mediated acquired thrombophilia. It is characterized by the presence of antiphospholipid antibodies (APL) that are directed against phospholipid-binding plasma proteins, such as beta-2-glycoprotein I (b2GPI). Its main manifestations are recurrent vascular thromboses (so-called "thrombotic APS") and pregnancy complications ("obstetric APS"). Read More

World J Pediatr Congenit Heart Surg 2018 Sep 10:2150135118783638. Epub 2018 Sep 10.

2 Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA.

A 24-year-old woman with a history of coarctation repair by subclavian flap aortoplasty presented at 15 weeks' gestation with transient episodes of vision loss. She was diagnosed with subclavian steal syndrome and underwent left carotid artery to subclavian artery bypass at 17 weeks' gestation. She has had no recurrence of symptoms at ten months of postoperative follow-up. Read More

JAMA 2018 09;320(9):911-917

Tufts University, Medford, Massachusetts.

Importance: Untreated syphilis infection in pregnant women can be transmitted to the fetus (congenital syphilis) at any time during pregnancy or at birth. Congenital syphilis is associated with stillbirth, neonatal death, and significant morbidity in infants (eg, bone deformities and neurologic impairment). After a steady decline from 2008 to 2012, cases of congenital syphilis markedly increased from 2012 to 2106, from 8. Read More

Neurol Ther 2018 Dec 30;7(2):207-232. Epub 2018 Aug 30.

Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.

Multiple sclerosis (MS) management presently aims to reach a state of no (or minimal) evidence of disease activity. The development and commercialization of new drugs has led to a renewed interest in family planning, since patients with MS may face a future with reduced (or no) disease-related neurological disability. The advice of neurologists is often sought by patients who want to have children and need to know more about disease control at conception and during pregnancy and the puerperium. Read More

J Matern Fetal Neonatal Med 2018 Sep 20:1-7. Epub 2018 Sep 20.

a Department of Ultrasonic Medicine and Fetal Medical Centre , the First Affiliated Hospital of Sun Yat-Sen University , Guangzhou , China.

Objectives: To explore chromosomal variations, including copy number variations (CNVs), in fetuses with conotruncal heart defect (CTD).

Methods: During a 5-year period, a total of 129 fetuses with ascertained CTDs were investigated for chromosomal abnormalities using quantitative fluorescence PCR (QF-PCR) and chromosomal microarray analysis (CMA). Fetuses were divided into two subgroups: benign group (with normal QF-PCR results and benign CNVs) and nonbenign group [with aneuploidies, nonbenign CNVs [pathogenic CNVs and CNVs of unknown significance (VOUS)]. Read More

PLoS One 2018 15;13(8):e0201452. Epub 2018 Aug 15.

Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom.

Zika virus infections can cause a range of neurologic disorders including congenital microcephaly. However, while Zika infections have been notified across all regions in Brazil, there has been an unusual number of congenital microcephaly case notifications concentrated in the Northeast of the country. To address this observation, we investigated epidemiological data (2014-2016) on arbovirus co-distribution, environmental and socio-economic factors for each region in Brazil. Read More

Front Physiol 2018 25;9:973. Epub 2018 Jul 25.

Department of Physiology, The Ruth and Burce Rappaport Faculty of Medicine, Technion-IIT, Haifa, Israel.

Preeclampsia is a serious complication of pregnancy where it affects 5-8% of all pregnancies. It increases the morbidity and mortality of both the fetus and pregnant woman, especially in developing countries. It deleteriously affects several vital organs, including the kidneys, liver, brain, and lung. Read More

J Neurol Sci 2018 Sep 30;392:94-99. Epub 2018 Jun 30.

Department of Neurology, , Brigham and Women's Hospital, Laboratory for Neuroimaging Research, Partners MS Center, Ann Romney Center for Neurologic Diseases, Harvard Medical School, Boston, MA, USA. Electronic address:

Objective: To assess the change in cerebral lesions and atrophy associated with pregnancy in patients with multiple sclerosis (MS).

Background: Multiple sclerosis often affects women of reproductive age. Disease stabilization typically occurs during pregnancy, with transient recrudescence post-partum. Read More

Nat Commun 2018 06 20;9(1):2414. Epub 2018 Jun 20.

California National Primate Research Center, University of California, 1 Shields Avenue, Davis, CA, 95616, USA.

Zika virus (ZIKV) infection of pregnant women can cause fetal microcephaly and other neurologic defects. We describe the development of a non-human primate model to better understand fetal pathogenesis. To reliably induce fetal infection at defined times, four pregnant rhesus macaques are inoculated intravenously and intraamniotically with ZIKV at gestational day (GD) 41, 50, 64, or 90, corresponding to first and second trimester of gestation. Read More

Public Health Rev 2018 15;39:10. Epub 2018 May 15.

1Centre Virchow-Villermé, Université Sorbonne Paris Cité, Paris, France.

While until recently the small and isolated Zika outbreaks in Eastern Asia and Pacific islands had been overlooked, the large-scale outbreak that started in Brazil in 2015 and the increase of microcephaly cases in the same place and time made media headlines. Considered as harmless until recently, Zika has given rise to an important global crisis that poses not only health challenges but also environmental, economical, social, and ethical challenges for states and people around the world. The main objective of this paper is to review the recent Zika outbreak by covering a broad range of disciplines and their interactions. Read More

PLoS One 2018 2;13(5):e0196025. Epub 2018 May 2.

Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.

Objective: To evaluate if concentrations of the neuronal proteins neurofilament light chain and tau are changed in women developing preeclampsia and to evaluate the ability of a combination of neurofilament light chain, tau, S100B and neuron specific enolase in identifying neurologic impairment before diagnosis of preeclampsia.

Methods: A nested case-control study within a longitudinal study cohort was performed. 469 healthy pregnant women were enrolled between 2004-2007 and plasma samples were collected at gestational weeks 10, 25, 28, 33 and 37. Read More

MMWR Recomm Rep 2018 04 27;67(2):1-44. Epub 2018 Apr 27.

Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.

This report compiles and summarizes all recommendations from CDC's Advisory Committee on Immunization Practices (ACIP) regarding prevention and control of tetanus, diphtheria, and pertussis in the United States. As a comprehensive summary of previously published recommendations, this report does not contain any new recommendations and replaces all previously published reports and policy notes; it is intended for use by clinicians and public health providers as a resource. ACIP recommends routine vaccination for tetanus, diphtheria, and pertussis. Read More

Hypertension 2018 Jun 23;71(6):1178-1184. Epub 2018 Apr 23.

From the Division of Neonatology (K.S.E., S.W.)

Preeclampsia has been shown to be associated with changes in cerebral structure and cognitive function later in life. Nf (neurofilaments) are specific scaffolding proteins of neurons, and their quantification in serum has been proposed as a biomarker for neuroaxonal injury. We performed a prospective, longitudinal, single-center study at the University Hospital of Basel to determine serum Nf concentrations in pregnant women with singleton pregnancies and with high risk of preeclampsia or with early signs of preeclampsia. Read More

MCN Am J Matern Child Nurs 2018 Mar/Apr;43(2):77-82

Courtney Stanley Sundin is a Clinical Nurse Supervisor, Labor & Delivery, Baylor Scott & White All Saints Medical Center, Andrews Women's Hospital, Fort Worth, TX. The author can be reached via e-mail at Michelle Laurane Johnson is a Charge Nurse, Labor & Delivery, Baylor Scott & White All Saints Medical Center, Andrews Women's Hospital, Fort Worth, TX.

Posterior reversible encephalopathy syndrome (PRES) is a newly defined syndrome; therefore, this transient clinical condition is not well known and probably underdiagnosed. It develops quickly with symptoms that are usually indistinguishable from eclampsia. Nurses need to be knowledgeable and aware of identifying symptoms and appropriate treatment. Read More

mSystems 2018 Jan-Feb;3(1). Epub 2018 Feb 6.

Huffington Center for Cell-Based Research in Parkinson's Disease, Black Family Stem Cell Institute, Department of Cell, Developmental and Regenerative Biology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.

Zika virus (ZIKV) infection during early pregnancy can cause microcephaly and associated defects at birth, but whether it can induce neurologic sequelae that appear later in life remains unclear. Using a model of the developing brain based on embryonic stem cell-derived brain organoids, we studied the impact of ZIKV infection on the DNA methylation pattern across the entire genome in selected neural cell types. The virus unexpectedly alters the DNA methylome of neural progenitors, astrocytes, and differentiated neurons at genes that have been implicated in the pathogenesis of a number of brain disorders, most prominently mental retardation and schizophrenia. Read More

Infect Dis Clin North Am 2018 03;32(1):215-224

Department of Pediatrics, Division of Infectious Diseases, Washington University in St. Louis, St. Louis Children's Hospital, Campus Box 8116, 1 Children's Place, St Louis, MO 63110, USA.

Zika virus is a mosquito-borne Flavivirus responsible for symptomatic and asymptomatic infections in humans. Zika was first identified in Africa as a cause of sporadic febrile illness. Beginning in 2015, Zika virus infection was identified in Brazil and linked with several symptomatic infections. Read More

Am J Obstet Gynecol 2018 04 17;218(4):440.e1-440.e36. Epub 2018 Jan 17.

Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Cediul-Cedifetal, Barranquilla, Colombia.

Background: Congenital Zika virus (ZIKV) infection can be detected in both the presence and absence of microcephaly and manifests as a number of signs and symptoms that are detected clinically and by neuroimaging. However, to date, qualitative and quantitative measures for the purpose of diagnosis and prognosis are limited.

Objectives: Main objectives of this study conducted on fetuses and infants with confirmed congenital Zika virus infection and detected brain abnormalities were (1) to assess the prevalence of microcephaly and the frequency of the anomalies that include a detailed description based on ultrasound and magnetic resonance imaging in fetuses and ultrasound, magnetic resonance imaging, and computed tomography imaging postnatally, (2) to provide quantitative measures of fetal and infant brain findings by magnetic resonance imaging with the use of volumetric analyses and diffusion-weighted imaging, and (3) to obtain additional information from placental and fetal histopathologic assessments and postnatal clinical evaluations. Read More

J Virol 2018 04 14;92(7). Epub 2018 Mar 14.

Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.

Human cytomegalovirus (HCMV) is the most common congenitally transmitted pathogen worldwide, impacting an estimated 1 million newborns annually. Congenital HCMV (cCMV) infection is a major global contributor to long-term neurologic deficits, including deafness, microcephaly, and neurodevelopmental delay, as well as to fetal loss and occasional infant mortality. Accordingly, design of a maternal vaccine to prevent cCMV continues to be a top public health priority. Read More

Am J Obstet Gynecol 2018 Mar 2;218(3):337.e1-337.e7. Epub 2018 Jan 2.

Antenatal Hypertension Clinic, Fetal Medicine Research Institute, King's College Hospital, London, UK. Electronic address:

Background: There is extensive evidence that prepregnancy chronic hypertension is associated with a high risk of development of severe hypertension and preeclampsia and birth of small-for-gestational-age neonates. However, previous studies have not reported whether antihypertensive use, blood pressure control, or normalization of blood pressure during early pregnancy influences the rates of these pregnancy complications.

Objective: The purpose of this study was to stratify women with prepregnancy chronic hypertension according to the use of antihypertensive medications and level of blood pressure control at the first hospital visit during the first trimester of pregnancy and to examine the rates of severe hypertension, preeclampsia, and birth of small-for-gestational-age neonates according to such stratification. Read More

Clin Infect Dis 2017 Dec;66(suppl_1):S30-S37

Office of the Director, NCEZID, Centers for Disease Control and Prevention, Atlanta, Georgia.

Background: Maternal and fetal outcomes associated with botulism and botulinum antitoxin use during pregnancy and the postpartum period have not been systematically reviewed.

Methods: We searched Global Health, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Scopus, and Medline databases from inception to May 2015 for studies published on botulism or botulinum antitoxin use during pregnancy and the postpartum period, as well as the Centers for Disease Control and Prevention National Botulism Surveillance database. Our search identified 4517 citations. Read More

Exp Neurol 2018 04 26;302:1-13. Epub 2017 Dec 26.

Department of Pediatrics, University of New Mexico School of Medicine, University of New Mexico, Albuquerque, NM, United States; Department of Neurosciences, University of New Mexico School of Medicine, University of New Mexico, Albuquerque, NM, United States.

Children who are born preterm are at risk for encephalopathy of prematurity, a leading cause of cerebral palsy, cognitive delay and behavioral disorders. Current interventions are limited and none have been shown to reverse cognitive and behavioral impairments, a primary determinant of poor quality of life for these children. Moreover, the mechanisms of perinatal brain injury that result in functional deficits and imaging abnormalities in the mature brain are poorly defined, limiting the potential to target interventions to those who may benefit most. Read More

J Headache Pain 2017 Dec 4;18(1):114. Epub 2017 Dec 4.

Department of Neurology with Experimental Neurology- Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.

Background: Acute headache is one of the most frequent neurological symptoms in pregnant women. The early diagnosis of underlying secondary conditions has a major influence on patient outcome, especially in emergency settings. However, at the time being no well-established guideline for diagnostic evaluation of acute headache during pregnancy exists. Read More

Semin Neurol 2017 12 21;37(6):712-723. Epub 2017 Dec 21.

Department of Radiology, Brigham and Women's Hospital & Harvard Medical School, Boston, Massachusetts.

Choosing the most appropriate diagnostic neuroimaging study for a pregnant woman involves assessing the pretest likelihood of serious treatable neurologic disease, the diagnostic utility of various available computed tomography (CT) and magnetic resonance (MR) modalities, and the risks of each. Of these three elements-pretest differential diagnosis, utility of MRI and CT, and risks of MR and CT-the risk component is perhaps the least well understood by most physicians. We provide a basic review of the intrinsic risks of MRI and CT, particularly radiation biology and radiation safety, as well as the risks pertaining to the use of contrast agents, to reduce provider confusion and anxiety and improve quality, safety, and efficiency of neuroimaging diagnosis in pregnant patients. Read More

Arch Med Res 2017 Nov 2;48(8):666-680. Epub 2017 Dec 2.

Unidad de Investigación en Enfermedades Infecciosas, Unidad Médica de Alta Especialidad, Hospital de Pediatría, Instituto Mexicano del Seguro Social, Centro Médico Nacional Siglo XXI, Ciudad de México, México. Electronic address:

Dysbiosis of the gut microbiota has been associated with increasing numbers of diseases, including obesity, diabetes, inflammatory bowel disease, asthma, allergy, cancer and even neurologic or behavioral disorders. The other side of the coin is that a healthy microbiota leads to a healthy human development, to a mature and well trained immune system and to an efficient metabolic machinery. What we have learned in adults is in the end the result of a good start, a programmed, healthy development of the microbiota that must occur in the early years of life, probably even starting during the fetal stage. Read More