The Use of Acetazolamide During Pregnancy in Intracranial Hypertension Patients

and Intracranial Hypertension Research Foundation (ET), Oregon Health and Science University, Portland, Oregon
Journal of neuro-ophthalmology: the official journal of the North American Neuro-Ophthalmology Society (Impact Factor: 1.95). 05/2012; 33(1). DOI: 10.1097/WNO.0b013e3182594001
Source: PubMed


BACKGROUND:: Acetazolamide is the mainstay of medical therapy for idiopathic intracranial hypertension (IIH). Its use in pregnant women has not been recommended because of reported teratogenic effects in rodents and rabbits. However, the safety of acetazolamide use during human pregnancy remains unclear. We report the pregnancy and offspring outcomes in women with intracranial hypertension (IH) treated with acetazolamide during pregnancy. METHODS:: Data were collected through questionnaires sent to patients with IH and their physicians. The questionnaires focused on IH diagnosis, obstetric history and outcomes, and pediatric outcomes. RESULTS:: A total of 101 women with IH were consented (total of 158 pregnancies) and acetazolamide usage before 13 weeks of gestation was reported in 50 pregnancies. The risk of spontaneous abortion was similar to the control group and no major complication was identified in the offspring of women treated with acetazolamide. CONCLUSION:: There is no convincing evidence for an adverse effect for acetazolamide use in human pregnancy, even when prescribed prior to the 13th week of gestation. While the liberal use of acetazolamide should be avoided during pregnancy, this medication should remain a treatment option in pregnant women when clinically indicated.

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    ABSTRACT: Opinion statement: Idiopathic intracranial hypertension (IIH, pseudotumor cerebri) is a syndrome of elevated intracranial pressure of unknown cause that occurs predominantly in obese women of childbearing age. It is a diagnosis of exclusion and, therefore, other causes of increased intracranial pressure must be sought with history, imaging, and cerebrospinal fluid examination before the diagnosis can be made. IIH produces symptoms and signs of increased intracranial pressure, including papilledema. If untreated, papilledema can cause progressive irreversible visual loss and optic atrophy. The treatment approach depends on the severity and time course of symptoms and visual loss, as determined by formal visual field testing. The main goals of treatment are alleviation of symptoms, including headache, and preservation of vision. All overweight IIH patients should be encouraged to enter a weight-management program with a goal of 5-10 % weight loss, along with a low-salt diet. When there is mild visual loss, medical treatment with acetazolamide should be initiated. Other medical treatments can be added or substituted when acetazolamide is insufficient as monotherapy or poorly tolerated. When visual loss is more severe or rapidly progressive, surgical interventions, such as optic nerve sheath fenestration or cerebrospinal fluid shunting, may be required to prevent further irreversible visual loss. The choice of intervention depends on the relative severity of symptoms and visual loss, as well as local expertise. At present, the role of transverse venous sinus stenting remains unclear. Although there are no evidence-based data to guide therapy, there is an ongoing randomized double-blind placebo-controlled treatment trial, investigating diet and acetazolamide therapy for IIH.
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    ABSTRACT: Headache is a common symptom in pregnant women. Although most headaches seen in women are primary headache disorders (migraine, tension-type headache), complications or conditions associated with pregnancy can present with a secondary headache. Headaches are common symptoms in idiopathic intracranial hypertension, eclampsia, and reversible cerebral vascular syndrome. Migraines may begin or worsen during pregnancy, but pregnancy tends to reduce migraine frequency and severity. Although it is desirable to avoid medications for headaches during pregnancy, treatment should be considered when headaches are severe and cause significant disability. Being aware of possible treatments for migraine and headaches during pregnancy is essential.
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