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Although peripheral neuropathy is not common in pregnancy, it is important that it be recognized and treated quickly since there is the uncommon potential for it to harm the mother and the fetus. Typically, symptoms associated with peripheral neuropathy during pregnancy are more bothersome than dangerous and they usually resolve after birth.

Neuropathies that may occur during pregnancy include:

• Mononeuropathy - the most common include:

  • facial nerve (Bell's palsy) - risk for developing this condition during or immediately following pregnancy is three times higher than for women who are not pregnant; third trimester or two weeks postpartum is the most common period for development of this condition. Typically there is complete or near complete recovery of facial strength. Treatment includes steroids and symptoms such as dry eye should be managed with ocular lubrication.
  • carpal tunnel syndrome - the incidence of carpal tunnel syndrome is higher among pregnant women than among the general population. It typically presents as pain at night and sensory abnormalities such as loss of sensation along the median nerve of the arm. Management is usually conservative since symptoms almost always resolve after childbirth. One study showed that 76% of cases resolved up to one month postpartum. Treatment includes wearing wrist orthoses, controlling edema, and avoiding occupational or other activities which exacerbate the condition.

• Polyneuropathy

  • acute immune demyelinating polyneuropathy (AIDP), also known as Guillain-Barre syndrome - it presents with an ascending symmetric weakness of the legs that can be quite severe and paresthesia. Reflexes are usually lost. AIDP develops most often in the third trimester. It is often preceded (approximately 65% of cases) by a viral syndrome. Respiratory function may be compromised and mechanical ventilation may be necessary in late pregnancy, a situation which raises the mother's risk for several other problems such as premature labor or thromboembolism. Management includes prevention of embolism and its complications, good hydration, continued observation for signs of autonomic dysfunction, plasmapheresis, and/or intravenous immunoglobulin (IVIG).
  • chronic immune demyelinating polyneuropathy (CIDP) involves sensory motor neuropathy. Onset is slower than AIDP and may follow a relapsing-remitting course. Symptoms may worsen during the last trimester or in the postpartum period. As with women who are not pregnant, management may include IVIG, plasmapheresis, and/or steroids.
  • diabetic neuropathy - this is a sensorimotor neuropathy that usually does not worsen during pregnancy but has a higher risk of developing during the postpartum period than in nondiabetic pregnant women. There is a direct relationship between the development or exacerbation of diabetic neuropathy during or immediately following pregnancy and glycemic control.
  • nutritional neuropathy is typically related to a vitamin deficiency of which thiamine and vitamin B6 are the most common. Thiamine deficiency causes sensorimotor neuropathy which is usually managed with intravenous thiamine and better attention to the inclusion of thiamine in the diet. Neuropathy almost always improves with treatment.
  • toxic neuropathy is usually related to medications for the mother. It has been associated with nitrofurantoin (Macrobid, Furadantin), an antibiotic prescribed for urinary tract infections. There is concern that the fetus may also develop neuropathy if this drug is given during the first trimester. Symptoms for the mother can be profound and may linger even after the medication is discontinued.