Peripheral Neuropathy: Issues for Pregnancy and Breastfeeding

Peripheral Neuropathy

If you suffer from any condition that affects one or more peripheral nerves—nerves located outside the brain or spinal cord—this is called peripheral neuropathy, and it can result from a variety of conditions. The most common cause is diabetes, in which case the nerve condition is called diabetic neuropathy. There also is alcoholic neuropathy, and also neuropathy that results from compression of nerves due to a problem with the skeletal system involving passages between bones through which nerves travel. One such condition is called carpal tunnel syndrome (CTS), which affects the hand because it results from compression of the median nerve as it passes through the carpal tunnel, the passageway through the bones of the wrist, known as the carpal bones. Another nerve compression condition is radiculopathy, resulting from compression of nerves where they enter and exit the spine. Mononeuropathy is a peripheral neuropathy that affects just one nerve, whereas neuropathy in many nerves is called polyneuropathy.

All of the types of peripheral neuropathies described above can occur during pregnancy. However, CTS is particularly common, creating problems in the hand, particularly pain and tingling, in 30-35 percent of pregnant women. Although less common than CTS in pregnant women, radiculopathy results in pain, tingling, muscle weakness, and other issues, because pressure from the growing womb exacerbates any compression of spinal nerves that already exists. Stretching of the abdomen and pelvis furthermore stretches nerves of the torso. One such nerve, called the ilioinguinal nerve, and others called the genital femoral nerves supply the lower abdomen, upper thigh, and structures around the genitals. This stretching can worsen difficulties that you already may have in movement and sensation in those areas of the body. Stretching of abdominal and pelvic nerves also can cause tingling in the abdomen as well as weakness in abdominal muscles.

If you received an episiotomy, a cut to increase the opening of the vagina when you gave birth in the past, you may suffer from numbness and problems with urination. This is due to neuropathy of a nerve called the pudendal nerve, which helps control sphincter muscles around the anus and urethra. The problem can thus be urinary stress incontinence, meaning that urine can be released against your will if you cough, laugh, sneeze, run, or perform some other physical activity. Fecal incontinence also is possible because of the problems with the anal sphincter.

As for diabetic neuropathy, women whose diabetes occurs only during pregnancy (gestational diabetes) tend not to develop diabetic neuropathy, but those with long-term diabetes (diabetes occurring outside of pregnancy) can indeed develop neuropathy. Women who abuse alcohol over a long period of time can suffer from alcoholic neuropathy whether they are pregnant or not.

All of the types of peripheral neuropathies can occur during pregnancy. However, carpal tunnel syndrome is particularly common, creating problems in the hand, particularly pain and tingling, in 30-35 percent of pregnant women.

If your doctor suspects peripheral neuropathy due to your medical history, particularly muscle weakness or tingling in particular parts of the body, a neurological examination will provide more clues. As an example, with CTS, tingling on the palm side of the hand, meaning the first three and a half fingers—thumb, index, middle and part of the ring finger—is an important clue. Your doctor may then order special tests. One group of tests is called nerve conduction studies (NCS), while another test is called electromyography (EMG). Also helpful are blood tests and imaging studies, such as magnetic resonance imaging (MRI).

One treatment approach for peripheral neuropathy is medication. Drugs to treat the condition consist of pain medication, although very strong painkillers called opioids should almost always be avoided in pregnant women. As for other drug categories given for peripheral neuropathy, some include drugs that must be avoided in pregnancy but also include drugs that are considered to be fairly safe in pregnancy. Such categories include anti-seizure medications and local anesthetics that are released gradually from patches placed on the skin. Certain antidepressants are given for peripheral neuropathy, some of which must be avoided during pregnancy while others are considered safe, and others that are not. One example of an antidepressant that is thought to be pregnancy safe, as well as breastfeeding safe, is duloxetine, which is useful in treating long-term pain of peripheral neuropathy. Capsaicin cream is another treatment that can be given for peripheral neuropathy during pregnancy.

After giving birth, if you require opioid medication for your peripheral neuropathy, it may be prudent to avoid breastfeeding. However, you should discuss the issue with your own doctor and also with your pediatrician. Often, medications can be switched to optimize the benefits and risks.

Whether you are pregnant or breastfeeding, there are several non-drug treatments that can be effective against the symptoms of peripheral neuropathy. Physical therapy with specialized exercise programs can be effective, as can transcutaneous electrical nerve stimulation (TENS), a procedure in which low current electricity is delivered through the skin to the affected nerve with varying frequency. Plasma exchange and intravenous immune globulin are examples of treatments that confront peripheral neuropathy by interfering with your immune system. There also are braces and other devices that you can wear to release nerve pressure, for instance in cases of CTS. Finally, in certain cases, surgery may be recommended to remove pressure from nerves.

David Warmflash
Dr. David Warmflash is a science communicator and physician with a research background in astrobiology and space medicine. He has completed research fellowships at NASA Johnson Space Center, the University of Pennsylvania, and Brandeis University. Since 2002, he has been collaborating with The Planetary Society on experiments helping us to understand the effects of deep space radiation on life forms, and since 2011 has worked nearly full time in medical writing and science journalism. His focus area includes the emergence of new biotechnologies and their impact on biomedicine, public health, and society.

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