Scoliosis & Pregnancy

There are many women out there who have concerns about getting pregnant when they have Scoliosis so I wanted to share my thoughts on this along with the thoughts of Dr Anita K Simmonds to help those who are worrying about pregnancy and scoliosis.

Idiopathic scoliosis is fairly common in young females

What are the risks of Pregnancy?
In most cases there are very few risks

You should ask yourself the following questions, however.
What are the health risks of pregnancy to a mother with scoliosis?
Will the baby inherit scoliosis? (25% chance of passing the baby Scoliosis)
What are the risks to the baby?
Are there likely to be any obstetric problems during the pregnancy or birth related to scoliosis?
Is the pregnancy likely to produce a progression in the spinal curve of the mother?
Am I fused, can the fusion cope with the strain?

Idiopathic Scoliosis
By this stage the developement of the lungs and heart is complete, and, apart from a mild degree of restricted lung capacity, individuals with adolescent onset scoliosis rarely encounter breathing problems during pregnancy

Congenital Scoliosis
Some people are born with Scoliosis and this is referred to as Congenital Scoliosis, it is usually associated with a neuromuscular condition such as muscular dystrophy or poliomyelitis, lung size may be more severly restricted because of failure of lung growth. Breathing will also be affected if the muscles that expand the rig cage are weak. A useful way to access lung size is to measure the vital capacity; this is carried out with a simple blowing test, which measures the total amount of air that can be actively expelled from the lungs after taking in maximum breath. If the vital capacity is less than 50% of predicted, a full review by a respiratory specialist is advisable.

Evidence suggests that as long as the vital capacity exceeds around 1.25 litres the outcome will probably be good. Below this level problems with a reduction in oxygen worsens on exertion and during sleep, and may be accompanied by a rise in the waste gas level (carbon dioxide). Low oxygen levels are harmful for the growing baby and can also lead to heart strain in the mother. Fortunately this situation is rare and monitoring of oxygen levels can be carried out easily during exercise and at night.

Provided that the oxygen levels of the mother are fine and heart function is good there should be no threat to the growth of the baby, and the enlarging uterus easily adapts to the shape of the mother

Idiopathic scoliosis is more than likely inherited on multiple genes, although Drs are looking closely at CHD7, Scoliosis can run in families but this is unusual (so information tells us currently) so the risks are relatively low, however, I do know a lady on my Scoliosis support group who had 4 children and all 4 of them have Scoliosis, she has Idiopathic Scoliosis and had surgery in her teens.

There are exciting new developments in the field of genetics, but we cannot yet detect Scoliosis in the genes, although they are now using DNA testing to help see how far the Scoliosis will decline!

Ultrasound scans of the baby will of course check overall growth, including spinal development. The exception to these comments are some of the congenital forms of Scoliosis, which are associated with conditions such as neurofibromatosis, and some types of myopathy and muscular dystrophy. These do run from generation to generation, and some conditions can be detected prenatally. Genetic counselling services exist in all regions of the UK and any individual with concerns can be referred for advice by their GP or specialist.

Breathing and Delivery
Large hormonal changes occur during pregnancy with an increase in oestrogen, progesterone, and relaxin. These help loosen the ligaments of the pelvis and lower spine to ease the birth of the baby. Although concerns have been raised that hormonal fluctuations could lead to a progression of a spinal curvature, most studies are reassuring on this point, suggesting that changes in the degree of Scoliosis are slight provided that the curvature is stable at the outset of pregnancy.

Some degree of breathlessness on exertion is common from early months of pregnancy in all women

This shortness of breath is partly caused by the rise in progesterone, which stimulates breathing by increasing respiratory rate and the depth of each breath. Blood volume also increases. These normal physiological changes are well tolerated and only likely to prove a problem if the vital capacity is low or heart function compromised.

Whereas Scoliosis that occurs in the chest region (thoracic - like mine was) may in theory affect breathing, a curvature in the low back region (lumbar) may potentially cause problems at the time of delivery, although in practice this is uncommon.

You should always discuss the management of labour in advance with the midwife, GP, Obstetrician and anaesthetist. The position adopted during labour ande delivery is crucial for comfort of the spine, and prolonged immobilisation is unhelpful. The most comfortable position will, of course, vary between individuals, and in most cases there is no reason why epidural injection should NOT BE USED, if this is the preferred method of pain control. However, if your fusion goes way into the lumnbar then you may find an epidural could not be acheived. This was partly my problem, an epidural would not have been advised for me and there were risks of my breaking the bottom of my spine.

Dr Phillip Zorab and Dr David Siegler completed a survey of 188 pregnancies in 64 women with Scoliosis and in that group:
No serious medical problems were encountered
17% of mothers reported increased breathlessness
21% had increased back pain but found it tolerable
17% required a caesarean section

My Dr said if I decided to go ahead and try to get pregnant then I would definitely need to pre-book a caesarean section.

To summarise, the results justify an optimistic look for patients with Scoliosis who wish to conceive, individuals with congenital or early-onset Scoliosis and those with weak muscles and heart problems should seek medical advice.

My surgery was almost stopped due to my heart problems and my muscles are very weak indeed, I am constantly having issues with muscle spasms and the smallest of things can set my muscles off into a tangent where I am suffering in pain.

I would discuss in length with your surgeon about pregnancy and perhaps consider counselling for those with Scoliosis.

Discussions in Counselling
Sensible Health Measures
Vitamin & Folate Supplements
Management of exisiting problems; asthma, hayfever, indigestion, diabetes

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