(668) Wernicke’s encephalopathy in pregnancy: a systematic review of pregnancy and neonatal outcomes

To assess and report pregnancy and neonatal outcomes related to Wernicke’s encephalopathy in pregnancy

Study Design:

We conducted a systematic review of six databases (MEDLINE, EMBASE, Emcare, the Cochrane Library, Web of Science: Core Collection, and Scopus). Articles from January 1^st, 2000 until June 1^st, 2024 were included. 

We included original observational articles that reported neonatal or fetal outcomes following a diagnosis of Wernicke’s encephalopathy in the context of a live intrauterine pregnancy. 

Descriptive statistics were used to aggregate results, as well as a nonparametric chi-square test and ANOVA. The Oxford Center of Evidence-Based Medicine grading tool was used to assess quality of evidence

Results:

After screening 1005 references, a total of 65 studies encompassing 88 patients were eligible for analysis, all of which were case series or case reports. The mean gestational age of Wernicke’s diagnosis was 16 ± 4.4 weeks. The majority of patients (55/88, 62.5%) had a live delivery, with 35 (63.6%) being reported as term delivery. Mean birthweight was 2523.64 grams. A total of 29 (32.9%) patients experienced pregnancy loss, with the majority (22/29, 75.9%) occurring before 20 weeks of gestation. Pregnancy loss was significantly associated with severe Wernicke’s disease (p=0.006), as well as delayed diagnosis (p=0.02). A total of 40 studies reported the mode of delivery, with 22 (55%) involving Cesarean deliveries and 18 (45%) involving vaginal deliveries. There was limited data available regarding neonatal outcomes, especially regarding long-term follow-up. Among the 54 live births, 35 (64.8%) were described simply as "healthy" or "eutrophic". Seven cases specifically noted no neonatal neurological concerns at birth.

Conclusion:

Although evidence regarding Wernicke’s encephalopathy in pregnancy is limited, it is crucial to counsel patients about the increased risk of pregnancy loss associated with severe Wernicke’s disease. Prompt diagnosis and treatment are essential, as delayed diagnosis is also more likely to result in pregnancy loss.