Objective:

To evaluate the safety of vaginal delivery and neuraxial anesthesia in women with idiopathic intracranial hypertension (IIH) and to examine the effects of the use of acetazolamide on neonatal outcomes. 

Background:

Management of IIH in pregnancy is an enormous challenge for the neurologists and maternal medicine specialists who care for these women.   Acetazolamide is an effective treatment for IIH, but its effects on offspring are unknown.  Vaginal delivery raises concern for potential worsening of the condition.  The safety of neuraxial anesthesia has not been previously assessed.

Design/Methods:

An electronic chart review was conducted to identify 180 pregnancies in women with IIH who received medical care within our health system between 2013 and 2023. Inclusion criteria included opening CSF pressure at or above 260 mm H2O pressure.  Data collected included: neonatal acetazolamide trimester of exposure and dose, spontaneous abortions, fetal demise, congenital anomalies, gestational age, length, weight, and head circumference at birth, APGAR scores, fetal health status at delivery, indication and mode of delivery, mode of anesthesia, and maternal complications of pregnancy and delivery. 

Results:

There was no significant difference in the rate of congenital anomalies (p = 0.3566) or spontaneous abortion (p = >0.9999) between acetazolamide-exposed offspring and non-acetazolamide-exposed offspring. There were no incidences of neurologic demise or visual loss in any of the patients, regardless of vaginal or cesarean section or type of anesthesia. 

Conclusions:

This study of 180 pregnancies of women with IIH revealed no neurologic deterioration who underwent vaginal delivery, epidural, or spinal anesthesia.  While this study is limited in size, no adverse effects of acetazolamide on offspring were noted.