PRE-PREGNANCY PLANNING

IIH is NOT a contraindication for future pregnancy. Weight loss in overweight and obese individuals is advised for IIH patients planning to become pregnant. Ideally, patients should delay until the disease is controlled, and off acetazolamide treatment.

 

INVESTIGATIONS

When the diagnosis of IIH is suspected following detection of papilledema, appropriate neuroimaging and lumbar puncture investigations are still required, and these should not be delayed. For pregnant women, non-contrast magnetic resonance imaging and venography is the appropriate imaging study of choice.

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MANAGEMENT

Regular eye examination is important in monitoring IIH, and the frequency of review is guided by patient symptoms and signs. Observation may be appropriate if no vision changes are evident.

Weight loss is an important management strategy for non-pregnant females, however, this excessive weight gain can have a detrimental impact on the foetus if not supervised.

 

Mental health states of depression and anxiety need to be acknowledged, in association with IIH to reduce the risk of post-partum depression. A balanced lifestyle is encouraged, with plenty of sleep and avoidance of skipping meals.

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Oral pain relief with paracetamol is useful to manage headaches and can be the only intervention during pregnancy. The risk of medication overuse headaches and safe paracetamol consumption needs to be explained.

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Acetazolamide is the main medication used to treat IIH. Although it is little evidence to support adverse effects throughout pregnancy, it has been advised to avoid in pregnancy prior to 20 weeks gestation due to the risk of foetal malformation.

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Topiramate is a teratogenic agent, and its use should be avoided throughout pregnancy. 

 

Lumbar punctures can be used both diagnostically and therapeutically during pregnancy, immediately reducing intracranial pressure. However, this procedure isn't without complications and can cause a low-pressure headache, and anxiety. Moreover, the cerebrospinal fluid in the brain can re-accumulate, leading to the recurrence of signs/symptoms. In such cases, serial lumbar punctures may be considered, especially for severe/deteriorating disease prior to considering surgical treatment.

 

Surgical treatments with cerebrospinal fluid diversion (shunt) and optic nerve sheath fenestration (ONSF) are options reserved for severe disease. Cases are rare in the literature,

 

DELIVERY

It appears the rate of spontaneous abortion is the same as the general population.

 

Moreover, there is no evidence to suggest natural (normal vaginal delivery) or assisted delivery (caesarean section) is more advantageous, so the decision should be guided by the obstetrician.