What is peripheral neuropathy?
Peripheral neuropathy is any condition affecting one or more nerves outside of the brain and spinal cord that comprise the central nervous system. The most common peripheral neuropathy conditions include diabetic neuropathy, alcoholic neuropathy, carpal tunnel syndrome (CTS), and radiculopathy. Diabetic neuropathy and alcoholic neuropathy are peripheral nerve disorders resulting in damage to nerves caused by diabetes and alcohol abuse, respectively. CTS is a problem affecting the hand, resulting from a nerve called the median nerve getting compressed as it travels through a passageway called the carpal tunnel, between the carpal bones of the wrist. Radiculopathy is a nerve problem resulting from a spinal nerve getting compressed along the pathway where it connects with other nerves. Peripheral neuropathy can be a mononeuropathy (affecting one nerve), or polyneuropathy (affecting more than one nerve).
How common is peripheral neuropathy in pregnancy?
The prevalence of peripheral neuropathy in pregnancy varies depending on the type of peripheral neuropathy, but CTS is extremely common, as 30-35 percent of pregnant women experience some kind of hand discomfort.
How is peripheral neuropathy diagnosed?
Peripheral neuropathy is diagnosed based on your medical history, especially your complaints of symptoms such as tingling in a body part, or weakness in the muscle group supplied by the affected nerve, combined with your physical examination, especially the neurological exam. In the case of CTS for instance, you would experience tingling and other difficulties on the part of the hand that is supplied by the median nerve, which is the palm side of the first three and a half fingers (thumb, index, middle and part of the ring finger. Subsequent to the neurological exam, your physician may send you for specialized tests, such as nerve conduction studies (NCS) and electromyography (EMG). Additionally, blood tests and imaging studies, such as magnetic resonance imaging, may be performed.
Does peripheral neuropathy cause problems during pregnancy?
CTS causes discomfort and difficulty using the hand during pregnancy, just as it does outside of pregnancy. Radiculopathy is less common than CTS, but pain, tingling, muscle weakness, and other problems from compression of spinal nerves can get worse during pregnancy as your womb grows.
Stretching of the pelvis and abdomen can cause sensory and movement difficulties, or make them worse, due to stretching of nerves in the torso, such as the ilioinguinal and genital femoral nerves that supply the lower abdomen, upper thigh, and structures around your genital region. Peripheral neuropathy from stretching of the pelvis and abdomen can also lead to weakness of lower abdominal muscles, as well as sensory symptoms on the abdomen, such as tingling. Women who have received episiotomies (incision at the opening of the vagina) during previous pregnancies can also experience peripheral neuropathy symptoms due to a compression injury of the pudendal nerve. This can show up as numbness as well as incontinence (urinary stress incontinence and/or fecal incontinence) during or after pregnancy. Incontinence can also result from injury of nerves that supply sphincter muscles.
Diabetic neuropathy usually does not develop in women who develop diabetes only during pregnancy (gestational diabetes), as it is the result of long-term disease. Alcoholic neuropathy is the result of alcohol abuse, which can cause many problems during pregnancy apart from neuropathy.
Does peripheral neuropathy during pregnancy cause problems for the baby?
Peripheral neuropathy does not cause problems for the baby if it is the result of nerve compression, such as in the case of CTS. On the other hand, if the neuropathy is the result of a disease process, such as long-standing diabetes, the underlying disease itself can be very harmful to the baby.
What to consider about taking medications when you are pregnant:
- The risks to yourself and your baby if you do not treat the peripheral neuropathy
- The risks and benefits of each medication you use when you are pregnant
- The risks and benefits of each medication you use when you are breastfeeding
What should I know about using medication to treat peripheral neuropathy during pregnancy?
Medications given to treat peripheral neuropathy may include pain medication, such as opioids, which should be avoided during pregnancy. Other drug categories, all of which include some medications that can be safe during pregnancy and others that should be avoided, include anti-seizure medications, patches that slowly release local anesthetics such as lidocaine to the region around the affected nerve to relieve pain, and antidepressants, some of which are safe during pregnancy, and others which are not. Antidepressants are used to treat the chronic pain of peripheral neuropathy, one example being duloxetine. A serotonin and norepinephrine reuptake inhibitor drug, Duloxetine is not thought to be dangerous during pregnancy, although studies have been limited.
Additionally, creams such as capsaicin cream are used sometimes to treat peripheral neuropathy symptoms, but you may experience a burning sensation on the site where you apply such creams.
Who should NOT stop taking medication for peripheral neuropathy in pregnancy?
Your physician can recommend particular medications that maximize effects against pain and other symptoms of neuropathy while minimizing risk to your developing baby. If such medications are working for you and reducing your suffering, there is no reason to stop using them during pregnancy.
What should I know about choosing a medication for peripheral neuropathy in pregnancy?
You may find Pregistrys expert reports about the individual medications to treat peripheral neuropathy here. Additional information can also be found in the sources listed at the end of this report.
What should I know about taking a medication for peripheral neuropathy when I am breastfeeding?
As noted above, for each medication category there is a choice of various medications that are effective against symptoms of peripheral neuropathy. In some cases, medications can be selected that are not thought to be dangerous in the setting of breastfeeding. Opioid medications, such as codeine and tramadol should be used with extreme caution if you are breastfeeding, and you should consider not breastfeeding and switching to an infant formula if these are the only medications that give you relief. Duloxetine is not known to be harmful in the setting of breastfeeding although more studies are needed to know this for sure.
What alternative therapies exist besides medications to treat peripheral neuropathy during pregnancy?
A range of non-drug treatments are effective in alleviating symptoms of peripheral neuropathy. These include physical therapy and specialized exercise programs, as well as a technique called transcutaneous electrical nerve stimulation (TENS) in which gentle electric currents at varying frequency are supplied through skin electrodes near the affected nerve. Other treatments include plasma exchange and intravenous immune globulin, which can improve certain cases of peripheral neuropathy by dampening the activity of your immu
ne system. Certain types of peripheral neuropathy, CTS for instance, can be treated with specially designed braces that you wear. Finally, there are surgical treatments, which can release entrapped nerves.
What can I do for myself and my baby when I have peripheral neuropathy during pregnancy?
Work with, and follow recommendations of your obstetrician, neurologist, orthopedic surgeon, physical therapist, and other specialists that attend you. Work with your doctors to choose a treatment strategy that minimizes your pain with minimal risk to your baby.
Resources for peripheral neuropathy during pregnancy:
For more information about peripheral neuropathy during pregnancy, contact http://www.womenshealth.gov/ (800-994-9662 [TDD: 888-220-5446]) or read the following articles:
- Mayo Clinic: Peripheral Neuropathy
- Baby Center: Carpal Tunnel Syndrome and Pregnancy