The Impact of Pregnancy on Functional Neurological Disorder (FND)

Functional neurological disorder (FND) commonly affects women of reproductive age, yet little is known about its interaction with pregnancy and childbirth. We aimed to explore FND symptom changes during pregnancy, delivery and the postpartum period and understand women's experiences of care.

We conducted a cross-sectional online survey of women with FND who had experienced pregnancy. The questionnaire was co-designed with clinicians and individuals with lived experience.

Of 111 respondents, 61 had experienced pregnancy after FND onset. Among 88 who provided onset data, 24% reported symptom onset during pregnancy, delivery, or postpartum, with 1 in 10 reporting onset specifically during the peripartum period. Seven participants described symptom onset or worsening following neuraxial (epidural/spinal) anaesthesia. On a group level, there was no significant change in FND symptoms across pregnancy phases or postpartum. FND symptoms did not worsen with vaginal delivery versus caesarean section. However, women who experienced hyperemesis gravidarum, daily headaches, or instrumented vaginal delivery were more likely to report FND symptom worsening. Although 35% expressed concern about FND during pregnancy and 13% changed pregnancy plans because of FND, the majority reported no difficulties with infant care or breastfeeding. Most participants (85%) received no FND-specific advice regarding pregnancy, and health professionals were generally perceived to have limited knowledge of FND.

While FND symptoms remain stable for most women during pregnancy, a subgroup experiences significant changes or new onset. There is an urgent need for prospective studies and for developing educational resources to guide care in this understudied area.