A 31-year-old female at 29 weeks of gestation presented with 2 days of sudden onset, progressively worsening, involuntary, rhythmic, semi-continuous, painless, jerking movements of the upper abdominal wall. She denies shortness of breath, fluctuations of movement with breathing, any exacerbating or relieving factors, non-positional, and was also witnessed to occur in sleep. Her medical history was notable for migraine and hyperemesis-gravidarum; obstetric history included one prior term spontaneous vaginal delivery and one early spontaneous miscarriage.

Her vitals, neurology exam were normal except for focal dyskinesias in the abdominal wall muscles. Routine evaluations were unremarkable, except for anemia (9.6 g/dL) and positive urine toxicology for THC. MRI brain, cervical, thoracic spine were non-significant except for mild thoracic disc bulges with canal stenosis and slight ventral cord flattening at the T6-T7 region without significant compressive pathology. Fetal assessment demonstrated with appropriate growth and a normal biophysical profile. The dyskinesia resolved within two days on clonazepam 0.5 mg three times daily. She was discharged on levetiracetam to avoid long-term benzodiazepines, with no further recurrence, and had an uncomplicated vaginal-delivery.

Our case demonstrates a rare movement disorder, raising awareness about BDD associated with pregnancy, with a benign outcome, which can cause intense stress and functional limitation. The underlying pathophysiology is elusive warranting further investigation. Clinician awareness is crucial to rule-out central etiology and recognize this rare entity early, ensuring the proper diagnosis to prevent misclassification as a functional neurological disorder and guide management.