Pregnancy and leprosy neuropathy.

Women with leprosy (even apparently cured) run a serious risk of deterioration in nerve function when they become pregnant. During pregnancy and lactation the woman with leprosy may suffer: relapse, reactivation and transient exacerbation maximally in late pregnancy; ENL in the first and third trimesters, continuing with nerve damage postpartum; RR maximally postpartum, even after MDT and RFT; neuritis affecting almost 50% of women in any pregnancy/lactation, in most cases as "silent" neuritis with new motor and sensory loss, even after MDT-RFT, and stocking-and-glove anaesthesia even in PB women and post MDT-RFT. Those incubating the infection develop overt disease frequently in reaction. This tragic cycle can only be stopped by a combination of: (i) leprologists and leprosy control personnel understanding the problems of leprosy in pregnant and lactating mothers; (ii) well-planned health education for leprosy patients, and both leprosy and maternal health care workers and (iii) the highest standard of clinical supervision during pregnancy, prolonged lactation and at regular intervals during the woman's reproductive life, even after she would normally be released from surveillance after completion of multiple drug treatment (MDT).