Pregnancy and leprosy: a comprehensive literature review.

The interaction between pregnancy, leprosy and leprosy reactions was examined in a systematic literature review. Several retrospective case series and one retrospective cohort study but only one prospective cohort study were identified in the English literature. Type 1 (reversal) reactions were particularly likely to occur during the post partum. This temporal association was also present for both overt and silent neuritis. Type 2 (erythema nodosum leprosum) reactions occur throughout pregnancy and during lactation, and may be severe and recurrent. No prospective, controlled studies were found that documented the complications of pregnancy in women treated with multidrug therapy regimens. Our study highlights the need for such studies, with appropriate controls, on women throughout pregnancy and lactation so that risk factors for reaction and neuritis during pregnancy can be identified and quantified.

Neuritis in pregnancy and lactation.

One hundred and forty-six women were studied during and after 153 pregnancies (31 healthy contacts: 34 pregnancies; 115 leprosy patients: 119 pregnancies). One healthy contact and 51 leprosy patients developed neuritis during the study period. All leprosy patients, including those who were considered to be cured and had stopped treatment, were at risk. Neuritis was accompanied by Type 1 and Type 2 lepra skin reactions and/or deterioration of the patients' leprosy status; this was particularly the case when neuritis was associated with nerve pain or tenderness (overt neuritis). Neuritis without nerve pain or tenderness (silent neuritis), preceded by the complaint of "rheumatism" and the clinical finding of enlarged peripheral nerves, was seen more frequently than overt neuritis (48:37 episodes). Insidious silent neuritis with loss of sensory and motor function during lactation was a particularly dangerous and hitherto undescribed risk of pregnancy.

Babies of mothers with leprosy have small placentae, low birth weights and grow slowly.

One hundred and sixteen women with leprosy and 31 healthy controls were studied throughout 155 pregnancies, and their babies were observed for a period of up to two years. Babies of mothers with leprosy weighed less than those of healthy mothers; the placental weights and coefficients followed the same trend. The babies of the mothers with leprosy grew more slowly than those of the healthy mothers and these findings were most marked in the babies of mothers with lepromatous leprosy. The cause of the reduced feto-placental weight is thought to be related to the immune status of the mother.