Metabolic Neurology, University of Birmingham Institute of Metabolism and Systems Research, Birmingham, UK
Neurology, Queen Elizabeth Hospital, Birmingham, UK.
Pract Neurol. 2022 Aug;22(4):295-300. doi: 10.1136/practneurol-2021-003152. Epub 2022 Apr 21.
Idiopathic intracranial hypertension (IIH) is more common in women of reproductive age who have obesity, yet there is little information on its management specifically in pregnancy. Women with IIH should plan their pregnancy including discussing contraception before pregnancy, recognising that hormonal contraceptives are not contraindicated. Potentially teratogenic medications including acetazolamide and topiramate are not recommended during pregnancy or in those with immediate plans to conceive; prescribing acetazolamide in pregnancy must only follow discussion with the patient and their obstetrician. Ideally, patients should aim to achieve disease remission or control before pregnancy, through optimising their weight. Although weight gain is expected in pregnancy, excessive weight gain may exacerbate IIH and increase maternal and fetal complications; evidence-based recommendations for non-IIH pregnancies may help in guiding optimal gestational weight gain. The vast majority of women with IIH can have a normal vaginal delivery, with spinal or epidural anaesthesia if needed, provided the papilloedema is stable or the IIH is in remission.
特发性颅内高压（IIH）在育龄肥胖女性中更为常见，但关于其在妊娠期间的具体管理信息甚少。患有 IIH 的女性应计划怀孕，包括在怀孕前讨论避孕措施，因为激素避孕药并不被禁用。乙酰唑胺和托吡酯等潜在致畸药物不建议在怀孕期间使用，也不建议在近期有怀孕计划的患者中使用；只有在与患者及其产科医生讨论后，才能在怀孕期间开乙酰唑胺处方。理想情况下，患者应通过优化体重，在怀孕前实现疾病缓解或控制。尽管怀孕期间体重会增加，但体重过度增加可能会使 IIH 恶化，并增加母婴并发症；针对非 IIH 妊娠的循证建议可能有助于指导最佳妊娠体重增加。绝大多数患有 IIH 的女性可以进行正常的阴道分娩，如果需要，可以进行脊髓或硬膜外麻醉，只要视乳头水肿稳定或 IIH 缓解即可。
