In pregnancy
What risks are associated with the development of Bell’s palsy during pregnancy?
Bell’s palsy occurs more often during pregnancy. In fact, researchers estimate that it may be three times more likely to develop in pregnant women versus non-pregnant women. Bell’s palsy occurs most frequently in the third trimester of pregnancy, or shortly after delivery in the postpartum period. The development of Bell’s palsy during pregnancy may be related to increased accumulation of fluid causing swelling (peripheral edema) leading to compression of the facial nerve, suppression of the immune system, or changes in the levels of certain hormones, such as estrogen, progesterone, and cortisol.
Bell’s palsy during pregnancy has been associated with high blood pressure (hypertension) and preeclampsia, a blood pressure disorder that can affect all of the organs in a woman’s body. Approximately 30% of cases of Bell’s palsy that develop during pregnancy are associated with preeclampsia or gestational hypertension (high blood pressure during pregnancy). Rarely, Bell’s palsy may be associated with another more severe disorder of high blood pressure called HELLP syndrome, which is a group of symptoms that occur in pregnancy women who have hemolysis, elevated liver enzymes, and low platelet count.
The authors of a review of 242,216 deliveries, including 42 cases of Bell’s palsy during pregnancy, concluded that Bell’s palsy is significantly associated with obesity, chronic hypertension, and severe preeclampsia. They stated that chronic hypertension and obesity are risk factors for the development of Bell’s palsy during pregnancy. Other authors have suggested that in some circumstances, Bell’s palsy might be a predictor of preeclampsia.
What are the risks to the fetus with Bell’s palsy during pregnancy?
Both preeclampsia and HELLP syndrome may lead to risks for the fetus including growth problems (growth restriction), preterm delivery, placental abruption (when the placenta prematurely detaches from the wall of the uterus), and the need for a cesarean delivery.
There have been few studies completed to determine the risk for fetal complications associated with Bell’s palsy. Some studies have found higher rates of cesarean delivery, preterm births, and low birth weight compared to the general population, while others have additionally reported a higher prevalence of low Apgar scores, and birth defects. More research is needed to truly determine the risks to the fetus.
What is the long-term outlook for women that develop Bell’s palsy during pregnancy?
In cases of Bell’s palsy associated with preeclampsia and/or HELLP syndrome, delivery may be recommended, both because severe pre-eclampsia and/or low platelet count can be threatening for the mother, and possibly in order to offer higher chances of prompt and complete resolution of Bell’s palsy.
One study followed 77 patients over a thirty year period to try to study the prognosis. The researchers found that the prognosis and likelihood for complete recovery from Bell’s palsy was worse for women in which complete facial paralysis occurred.
Source:
https://rarediseases.info.nih.gov/diseases/5906/bells-palsy/cases/60328
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