Decision to overturn Roe v. Wade will ‘undoubtedly’ affect those in the field of neurology

The U.S. Supreme Court’s recent decision to overturn Roe v. Wade will compromise standard neurological care for approximately 40 million women in as many as 28 states, educators wrote in JAMA Neurology.

Sara C. LaHue, MD, assistant professor of neurology at the University of California, San Francisco, and colleagues recently submitted an editorial detailing the immediate, negative effects of overturning Roe v. Wade, which was established in 1973.

“The Supreme Court's decision will undoubtedly now have an impact on all of us in the field of neurology,” LaHue and colleagues wrote. “Bans on abortion will immediately affect the delivery of current standard neurologic care for many patients, specifically standards that depend on planning or preventing pregnancies using individual choice.”

According to the authors, many neurologic diseases disproportionately affect women during their reproductive years and include common conditions such as migraine, as well as epilepsy and MS. Teratogenic medications may be required to achieve control over neurological diseases, which could be life-threatening or result in irreversible disabilities.

“Concerns about medication teratogenicity for those who are anticipating pregnancy or are pregnant may extend beyond medications with clearly established teratogenicity and include medications that lack evidence supporting their safety profiles,” the authors wrote.

Some conditions, including eclampsia, may occur before fetal viability, the authors noted, and increase the risk of morbidity and mortality for the mother if the pregnancy cannot be terminated.

Other neurological diseases, such as a central nervous system neoplasm, are not immediately life threatening, but like eclampsia, a delay in treatment could put the health and life of the mother at risk.

Moreover, anatomic ultrasounds, which commonly occur at 20 weeks’ gestation to evaluate the growth and health of the fetus, placental position and amniotic fluid volume, may identify fetal neurological conditions that are not survivable or could cause poor quality of life.

“If pregnancy termination is banned, then women may be forced against their wishes to deliver a newborn that may require prolonged intensive care and end-of-life care,” LaHue and colleagues wrote. “The loss of bodily autonomy for pregnant women in such a scenario conscripts the dyad of mother and child to potential physical and psychological morbidity.”

The authors urge neurologists to consider “how legislating private health decision between patients and clinicians might alter the landscape of neurologic practice” throughout the patient’s life.

“Equity in care depends on the unrestricted liberty to make personal decisions affecting bodily autonomy,” the authors wrote. “This includes optimization of fertility windows, personal determination of pregnancy timing to limit disease progression or exacerbation, and pregnancy termination if necessary for the health of the mother, the fetus or both.”