New Neuro-Obstetrics Clinic Provides Multidisciplinary Care for Women with Neurological Conditions Facing High-Risk Pregnancy

A new multidisciplinary clinic housed at UPMC Magee-Womens Hospital brings together experts from the UPMC Division of Women’s Neurology and The Division of Maternal Fetal Medicine at UPMC Magee to provide specialized, high-acuity care with underlying neurologic conditions who are pregnant or planning pregnancy, or women who experience a new onset neurologic issue while pregnant.

The clinic, which launched in July 2025, was conceived and structured by Eliza Miller, MD, MS, chief, UPMC Division of Women’s Neurology. Division colleague Denise Li, MD, and Arun Jeyabalan, MD, MSCR, chief, Division of Maternal Fetal Medicine at UPMC Magee, partnered with Dr. Miller to create the clinic. Physician support within the clinic comes from numerous providers in both Divisions, with Dr. Li and Dr. Jeyabalan providing frequent coverage. Women’s neurology specialist, Mary A. O’Neal, MD, who recently joined UPMC and the University of Pittsburgh, also will be providing care in the clinic on a regular basis.

Pictured from left to right: Eliza Miller, MD, MS, Denise Li, MD, and Arun Jeyabalan, MD, MSCR.

The new Neuro-Obstetrics Clinic works on an integrated model designed to streamline access, improve safety, and ensure unified management for neurologic conditions that intersect with the unique physiologic changes that occur during pregnancy.

“The idea behind the Neuro-Obstetrics Clinic is to provide an easy, direct pathway for high-risk pregnant patients who need neurologic expertise. Many of these patients cannot wait months for a neurology appointment. They need to be seen quickly, and they need pregnancy-specific guidance,” Dr. Miller says.

Clinical Rationale, Structure, and Goals

The clinic was created to address a significant gap in care: expertise in pregnancy-specific neurologic care. Many neurologists and general obstetric providers lack familiarity with how neurological disorders behave during pregnancy or how pregnancy itself can unmask or worsen neurologic disease. Women with neurologic conditions often require pregnancy-specific medication adjustments, risk assessment, and multidisciplinary delivery planning.

“Pregnancy has a unique physiology, and neurologic conditions can behave differently in this setting. Even disorders that were stable before pregnancy may change, and some can manifest for the first time during pregnancy. Working together ensures that our goals are aligned for both maternal and fetal care,” Dr. Jeyabalan says.

Dr. Li, Dr. Jeyabalan, and colleagues currently hold clinic sessions twice per month for a half day with plans to expand the schedule as patient volume grows. They take a flexible approach to patient scheduling, arranging same-day evaluations by both services when possible. Because many patients live far from UPMC Magee in Pittsburgh, the team uses telemedicine extensively to support access.

“Sharing a clinical space helps patients see that their neurologists and maternal fetal medicine specialists are working together toward the same goals, and it streamlines the care they need during pregnancy,” Dr. Li says.

When a patient’s neurologic condition affects labor or delivery planning, the team collaborates with obstetric anesthesiology and other subspecialists as needed.

This structure allows the clinic to coordinate evaluations efficiently and maintain consistent recommendations from outpatient visits through delivery.

“Our collaboration allows us to bring in the right subspecialists quickly to create a unified plan that supports safe pregnancy and delivery for patients with neurological conditions,” Dr. Jeyabalan says.

Patient Populations

The Neuro-Obstetrics Clinic evaluates a broad spectrum of patients whose neurologic needs intersect directly with pregnancy and where delays in recognition, diagnosis, and care can lead to maternal or fetal harm.

Epilepsy is one of the most common conditions, but the clinic also manages patients with:

• Prior stroke.
• Intracranial vascular anomalies.
• Idiopathic intracranial hypertension.
• Neuroimmunology diseases, e.g., multiple sclerosis.
• Chronic headache disorders.

Patient care is focused on optimizing disease control before conception, modifying therapies with known teratogenic risks, and preparing individualized management plans for pregnancy, delivery, and the postpartum period.

“Preconception planning, expectations around how a condition may change in pregnancy, and discussions about medication adjustments are all essential. These are conversations many patients have never had before their pregnancy,” Dr. Li says.

The Neuro-Obstetrics Clinic also sees patients who become pregnant while already under neurologic care and require pregnancy-adapted treatment and monitoring. Many of these conditions require attention to medication pharmacokinetics, mitigating the risk of relapse or the potential for disease exacerbation that can occur during or after pregnancy.

Anti-seizure medications often require trimester-specific dose adjustments.

Neuroimmunology conditions like MS are well-known to flare or worsen in the postpartum period. Various types of cerebrovascular disorders can be altered by the normal hemodynamic changes that occur during pregnancy. For these patients, coordinated evaluation between neurology, maternal fetal medicine, obstetric anesthesiology, and when needed, cardiology or neurosurgery, leads to comprehensive care management decisions that are aligned across providers.

When Emergencies and Hospitalizations Occur

Another segment of patients the Neuro-Obstetrics Clinic follows includes individuals who develop new or unexpected neurologic symptoms, complications, or emergencies during pregnancy. These can include severe headache, new-onset seizures, focal deficits, or visual changes, all of which represent serious pregnancy-specific emergent pathologies, including:

• Preeclampsia or eclampsia.
• Reversible cerebral vasoconstriction syndrome.
• Posterior reversible encephalopathy syndrome.
• Cerebral venous thrombosis.
• Acute stroke.

When pregnant patients without prior neurologic conditions arrive at the emergency department or are otherwise hospitalized for a neurologic issue, the women’s neurology and maternal fetal medicine experts from the Neuro-Obstetrics Clinic have an integrated inpatient presence at UPMC Magee and work together with the emergency department and inpatient teams when patients require urgent evaluation and care.

The same clinicians who care for pregnant patients in the outpatient Neuro-Obstetrics Clinic participate in inpatient assessments and care and, conversely, can follow these patients once they are stabilized, discharged, and need longitudinal outpatient follow-up and monitoring for the remainder of the pregnancy.

“Symptoms that might be benign in a nonpregnant adult can signal rapidly evolving disease in pregnancy. When this occurs, these cases should be immediately referred to the emergency department or hospital,” Dr. Li says. “At UPMC Magee, there is a strong, long-standing collaboration between obstetrics and neurology for inpatient cases, which then translates to our outpatient clinic.”

Patient Referrals and Consultations

Referring physicians should contact kunkellm@upmc.edu for patient referrals and consultation requests.