Management of Bell's palsy in pregnancy: A retrospective case-control study

Abstract Introduction: Bell's palsy (BP) is a condition characterized by acute onset facial nerve paresis. The prevalence of BP is three times higher during pregnancy and has been associated with more severe disease and inferior outcomes. Previous studies have demonstrated that pregnant women are not provided with the standard of care. This study aims to review the diagnosis of Bell's palsy in pregnancy as well to compare management and recovery to a non-pregnant population. Methods: A retrospective case-control study was conducted of patients with a diagnosis of Bell's palsy during pregnancy or in the first six weeks postpartum seen in HHS or SJHH hospitals from 2010 to 2025. Age-matched controls (±5 years) were randomly selected from the same period. 52 women were included with 50 non-pregnant controls. Results: The majority of patients developed BP in their third trimester. There was no difference in House–Brackmann score between cases and controls (3.38 versus 3.08, p = 0.18), although there was a trend to more severe classification in the pregnant group (42% versus 24%, p = 0.28). There was no difference in timing or dosing of corticosteroid therapy, although there was a trend to less anti-viral therapy being provided (56% of controls versus 38% of cases, p = 0.10). There were no statistically significant differences in recovery outcomes, although more cases had partial or no recovery. Discussion: Contemporary management practices may be narrowing the previously reported gap in care. Development of pregnancy-specific recommendations within existing guidelines is of utmost importance to support clinical decision making.