Pregnancy: prognosis, course, and risks in untreated and treated narcolepsy/hypersomnia patients

Literature on hypersomnia/hypersomnolence concerning contraception, fertility, pregnancy, breast feeding, and medication is scarce and exists so far only for patients with narcolepsy. Full prescribing information of drugs approved for narcolepsy and other hypersomnias are mainly unspecific. There is some data showing metabolic risks for narcolepsy patients during pregnancy that should be pointed out and controlled. Patients and partners planning pregnancy should be informed about the fertility risks of certain medications and the interaction of different drugs before, during, and after pregnancy. Collaboration between the general practitioner, obstetrician, and sleep specialist before, during, and after pregnancy is desirable. Some drugs can be administered at the lowest doses during pregnancy in monotherapy. Psychological problems after delivery can occur. The risk of cataplexy during delivery is very low. Most patients have spontaneous deliveries and almost 3/4 of women breastfeed. Malformations can occur and are not more frequent than in the general population; with some drugs, e.g. modafinil, they can be increased.