Bell's Palsy in Pregnancy and Postpartum: A Retrospective Case‐Control Study of 182 Patients

Abstract

Objective To assess the incidence of Bell's palsy in pregnant and postpartum women. Additionally, to compare facial outcomes in terms of Sunnybrook score following Bell's palsy with regard to corticosteroid treatment and other confounding factors. Study Design Retrospective case‐control study. Setting University Hospital, Stockholm, Sweden. Methods All women with Bell's palsy in pregnancy or postpartum (6 weeks after birth) with a computerized medical chart in the Stockholm Region 2005 to 2015 were included. The total number of births in the region during this period was retrieved from the Swedish Medical Birth Register. Nonpregnant age‐matched women with Bell's palsy served as controls. Characteristics, medication, and Sunnybrook scores were collected. Risk factors for incomplete recovery (Sunnybrook score <96) at 3 months were calculated by logistic regression. Results In total, 182 pregnant and postpartum women with Bell's palsy were identified. The estimated incidence among pregnant and postpartum women was 60.5/100,000 person‐years. The mean Sunnybrook score at 3 months was 74 among pregnant and postpartum women and 83 for controls (p = .002). At 12 months, Sunnybrook score was 81 and 89, respectively (p = .017). Only one‐third of the pregnant women received corticosteroid treatment. Conclusion The incidence of Bell's palsy in pregnancy and postpartum was 60.5 per 100,000 women and year in the Stockholm Region. Sunnybrook score was poorer in pregnant women compared with postpartum and nonpregnant women throughout. Corticosteroid treatment had little effect on any patients, however, only one‐third of the pregnant women received this treatment.

Bell's palsy in pregnancy: A scoping review of risk factors, treatment and outcomes

“…They also found that facial function at the initial visit was the most important prognosticator. Researchers were unable to demonstrate an effect of corticosteroid treatment and as discussed previously only a third of pregnant women in their study received this treatment 20 . Phillips et al found worse long‐term facial function outcomes in pregnant women with BP than nonpregnant controls.…”

“…Shmorgun et al 16 Lansing et al 20 pregnancies in their cohort were twin pregnancies, which is higher than the general obstetric population at 3%. 16,17 Multifoetal pregnancies are also known to be at higher risk for pre-eclampsia.…”

“…Researchers were unable to demonstrate an effect of corticosteroid treatment and as discussed previously only a third of pregnant women in their study received this treatment. 20 Phillips et al found worse long‐term facial function outcomes in pregnant women with BP than nonpregnant controls. They reported their results by way of median eFACE (clinician graded facial function score).…”

“…Insufficient data and study heterogeneity meant we were unable to assess benefit from treatments given in the pooled studies. Gillman et al found that pregnant women with BP were far less likely to be prescribed corticosteroids and antivirals than nonpregnant controls with BP which was echoed by Phillips et al and Lansing et al [20][21][22] The latter study suggests that the risk of teratogenicity may lead clinicians to be more conservative with medical therapy in pregnant patients. The use of systemic corticosteroid in the first trimester may confer a modest increase in the risk of cleft lip with or without cleft palate.…”

“…Researchers were unable to demonstrate an effect of corticosteroid treatment and as discussed previously only a third of pregnant women in their study received this treatment. 20 There are numerous reports of facial function outcomes in nonpregnant cohorts. Complete recovery rates of 85%-95% with early corticosteroid treatment have been reported.…”