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Racca F, Longhitano Y, Zanza C, Balzanelli MG, Draisci G, Stoia PA, Gollo E, Maio M, Grattarola C, Astuto M, Ciccarelli A, Racca G, Romenskaya T, Giordano B, Serraino A, Sansone VAM, Gregoretti C, Conti G, Piccolella F, Vaschetto R. Peri-partum respiratory management of pregnant women with neuro-muscular disorders: a prospective observational study (IT-NEUMA-Pregn study). BMC Anesthesiol 2023; 23:342. [PMID: 37833635 PMCID: PMC10571352 DOI: 10.1186/s12871-023-02307-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 10/09/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Pregnant women with neuromuscular diseases (NMDs) often display respiratory muscle impairment which increases the risk for pulmonary complications (PCs). The aim of this study was to identify pregnant NMDs patients with pulmonary risk factors and to apply in these women non-invasive ventilation (NIV) combined with mechanical insufflation-exsufflation (MI-E) in the peri-partum period. METHODS We conducted a multicenter observational study on women with NMDs undergoing cesarean section or spontaneous labor in a network of 7 national hospitals. In these subjects we applied a protocol for screening and preventing PCs, and we evaluated PCs rate, maternal and neonatal outcome. RESULTS Twenty-four patients out of the 94 enrolled pregnant women were at risk for PCs and were trained or retrained to use NIV and/or MI-E before delivery. After delivery, 17 patients required NIV with or without MI-E. Despite nine out of the 24 women at pulmonary risk developed postpartum PCs, none of them needed reintubation nor tracheostomy. In addition, the average birth weight and Apgar score were normal. Only one patient without pulmonary risk factors developed postpartum PCs. CONCLUSION This study showed the feasibility of applying a protocol for screening and treating pregnant NMDs women with pulmonary risk. Despite a PCs rate of 37% was observed in these patients, maternal and neonatal outcome were favorable.
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Affiliation(s)
- Fabrizio Racca
- Department of Anesthesiology and Intensive Care, Azienda Ospedaliera SS. Antonio E Biagio E Cesare Arrigo, Alessandria, Italy
- Division of Anesthesia and Critical Care Medicine, Azienda Ospedaliera Ordine Mauriziano, Turin, Italy
| | - Yaroslava Longhitano
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Christian Zanza
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
- Post Graduate School of Geriatric Medicine, University of Rome "Tor Vergata", Rome, Italy.
| | | | - Gaetano Draisci
- Institute of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Paolo Augusto Stoia
- Anesthesiology and Intensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda Ca'Granda, Milan, Italy
| | - Evelina Gollo
- Department of Anesthesiology and Intensive Care A.O.U. Città Della Salute E Della Scienza Di Torino, Turin, Italy
| | - Mariella Maio
- Department of Anesthesiology and Intensive Care A.O.U. Città Della Salute E Della Scienza Di Torino, Turin, Italy
| | - Claudia Grattarola
- Anesthesiology and Intensive Care Unit, Istituto Giannina Gaslini, Genova, Italy
| | - Marinella Astuto
- Dipartimento Chirurgia Generale e Specialità Medico Chirurgiche, A.O.Universitaria "Policlinico-Vittorio Emanuele", Università Degli Studi Di Catania, Catania, Italy
| | - Antonello Ciccarelli
- Department of Movement, Human, and Health Sciences - Division of Health Sciences, University of Rome "Foro Italico, Rome, Italy
| | - Giulia Racca
- Division of Anesthesia and Critical Care Medicine, Azienda Ospedaliera Ordine Mauriziano, Turin, Italy
| | - Tatsiana Romenskaya
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Benedetta Giordano
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | | | - Valeria Ada Maria Sansone
- The NEMO Clinical Center in Milan, Neurorehabilitation Unit, University of Milan- ERN for Neuromuscular Diseases, Milan, Italy
| | - Cesare Gregoretti
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy
- Fondazione Istituto "G. Giglio" Cefalù, Palermo, Italy
| | - Giorgio Conti
- Institute of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Fabio Piccolella
- Department of Anesthesiology and Intensive Care, Azienda Ospedaliera SS. Antonio E Biagio E Cesare Arrigo, Alessandria, Italy
| | - Rosanna Vaschetto
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
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Cavalcanti EBU, Leal RDCC, Marques Junior W, Nascimento OJMD. Charcot-Marie-Tooth disease: from historical landmarks in Brazil to current care perspectives. ARQUIVOS DE NEURO-PSIQUIATRIA 2023; 81:913-921. [PMID: 37611635 PMCID: PMC10631856 DOI: 10.1055/s-0043-1770348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 03/16/2023] [Indexed: 08/25/2023]
Abstract
Hereditary motor and sensory neuropathy, also known as Charcot-Marie-Tooth disease (CMT), traditionally refers to a group of genetic disorders in which neuropathy is the main or sole feature. Its prevalence varies according to different populations studied, with an estimate between 1:2,500 to 1:10,000. Since the identification of PMP22 gene duplication on chromosome 17 by Vance et al., in 1989, more than 100 genes have been related to this group of disorders, and we have seen advances in the care of patients, with identification of associated conditions and better supportive treatments, including clinical and surgical interventions. Also, with discoveries in the field of genetics, including RNA interference and gene editing techniques, new treatment perspectives begin to emerge. In the present work, we report the most import landmarks regarding CMT research in Brazil and provide a comprehensive review on topics such as frequency of different genes associated with CMT in our population, prevalence of pain, impact on pregnancy, respiratory features, and development of new therapies.
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Affiliation(s)
| | | | - Wilson Marques Junior
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurologia, Ribeirão Preto SP, Brazil.
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Dommergues M, Candilis D, Becerra L, Thoueille E, Cohen D, Viaux-Savelon S. Childbirth and motherhood in women with motor disability due to a rare condition: an exploratory study. Orphanet J Rare Dis 2021; 16:176. [PMID: 33849607 PMCID: PMC8045243 DOI: 10.1186/s13023-021-01810-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/31/2021] [Indexed: 11/28/2022] Open
Abstract
Background Rare diseases may result in motor impairment, which in turn may affect parenthood. Our purpose was to evaluate perinatal outcomes, parenting needs, mother-infant interactions and infant development in a set of volunteer women with motor impairment due to a rare disease. In a parenting support institution, we recruited a consecutive series of 22 volunteer pregnant women or young mothers, recorded perinatal outcomes, and followed mother-infant interaction and relationship and infant development up to 14 months postpartum. Cases with intellectual or psychic disability were not included. Results There were 11 genetic diseases (2 Spinal Muscular Atrophy, 1 Charcot-Marie-Tooth, 1 autosomal dominants myopathy, 1 mitochondrial disease, 2 Elhers-Danlos, 1 Friedreich ataxia, 1 spinocerebellar ataxia, 1 tetrahydrobiopterine deficiency,1 Ectrodactyly), and 11 rare non-genetic conditions (2 spine tumors, 2 strokes, 1 juvenile chronic arthritis, 3 birth injuries, 1 inflammatory myopathy, 1 congenital amputation, and 1 traumatic amputation). These resulted in 10 impairments of four limbs, 4 impairments of both lower limbs, 7 unilateral impairments, and one distal tremor. Social deprivation Epices score, Cutrona social support scale, Edinburg Postnatal Depression scale, and Spielberger State/Trait Anxiety Inventory were unremarkable. Perinatal outcome: 4 gestational diabetes, 1 pre-eclampsia, 9 caesareans, 6 assisted and 7 spontaneous vaginal deliveries, 20 term live-births and 2 premature deliveries (35–36 weeks). Twelve women declared they were self-sufficient for daily activities; six declared they were self-sufficient to provide basic care to their baby. Distribution of the Brunet-Lezine child development score was normal. The parent-infant relationship global assessment scale (PIR-GAS) was well adapted in 2 cases, adapted in 8, perturbed in 7, significantly perturbed in 2, and distressed in 3 (mean 71.8; 95% CI 49.6–93.9). This was unrelated to any somatic or emotional characteristics of the participants. Coding interactive behavior revealed that infant engagement was lower and infant avoidance greater than in controls (p < 0.05). Conclusion Infant development was normal, but mother-infant interactions were altered in half of the participants independently from the degree of motor impairment, underscoring the need for parenting support, even for parents who are self-sufficient in daily activities.
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Affiliation(s)
- Marc Dommergues
- Department of Obstetrics and Gynecology, Hopital Pitié Salpêtrière APHP and Sorbonne Université, 83 Boulevard de l'Hopital, 75013, Paris, France.
| | | | - Ludivine Becerra
- Service d'Aide à la Parentalité des Personnes en Situation de Handicap, Paris, France
| | - Edith Thoueille
- Service d'Aide à la Parentalité des Personnes en Situation de Handicap, Paris, France
| | - David Cohen
- Child Psychiatry, Hopital Pitié Salpêtrière APHP and Sorbonne Université, Paris, France
| | - Sylvie Viaux-Savelon
- Child Psychiatry, Hopital Pitié Salpêtrière APHP and Sorbonne Université, Paris, France
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Mandeville RM, Narayanaswami P. The birth of informed decisions: Pregnancy and muscular dystrophy. Muscle Nerve 2021; 63:787-789. [PMID: 33760246 DOI: 10.1002/mus.27242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 03/21/2021] [Accepted: 03/22/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Ross M Mandeville
- Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, USA
| | - Pushpa Narayanaswami
- Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, USA
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Zagorda B, Camdessanché JP, Féasson L. Pregnancy and myopathies: Reciprocal impacts between pregnancy, delivery, and myopathies and their treatments. A clinical review. Rev Neurol (Paris) 2021; 177:225-234. [PMID: 33648783 DOI: 10.1016/j.neurol.2020.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 09/07/2020] [Accepted: 09/30/2020] [Indexed: 11/16/2022]
Abstract
During pregnancy, women undergo physical and physiological changes, which can impact the neuromuscular disease course, but also delivery and fetus health. Generally, there is little impact on the disease course, but sometimes an impairment is noticed, which could be attributed to pregnancy and not to disease progression. Cardiac and respiratory functions have to be assessed at the beginning of pregnancy and a close follow-up is mandatory in case of disorder. Labour and delivery are often impacted. Labour is prolonged because of muscle weakness that is an increased risk of instrumental delivery or Cesarean sections. Patients with myotonic dystrophy are at risk of postpartum hemorrhage. Fetal loss can be associated with fetal disease in myotonic dystrophy, and is at high risk for patients with active inflammatory myopathy only.
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Affiliation(s)
- B Zagorda
- Service de médecine physique et de réadaptation, Hôpital Bellevue, CHU de Saint-Étienne, Saint-Étienne, France; Centre référent maladies neuromusculaires rares, CHU de St Étienne, Euro-NmD, Saint-Étienne, France
| | - J-P Camdessanché
- Service de neurologie, Hôpital Nord, CHU de Saint-Étienne, Saint-Étienne, France; Centre référent maladies neuromusculaires rares, CHU de St Étienne, Euro-NmD, Saint-Étienne, France
| | - L Féasson
- Unité de myologie, service de physiologie clinique et de l'exercice, Hôpital Nord, CHU de Saint-Étienne, Saint-Étienne, France; Centre référent maladies neuromusculaires rares, CHU de St Étienne, Euro-NmD, Saint-Étienne, France.
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6
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Charcot-Marie-Tooth neuropathy and pregnancy: general and specific issues. MED GENET-BERLIN 2020. [DOI: 10.1515/medgen-2020-2031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Background:
Charcot-Marie-Tooth (CMT) neuropathies represent an important group of neuromuscular disorders and are mostly autosomal dominantly inherited. The question, if there is a higher complication rate in pregnancy and delivery in CMT neuropathy and if there is a possible influence of pregnancy on muscles and nerves themselves, is important for medical care and prepregnancy counselling of affected women.
Objectives:
In this review we first address general issues of the clinical picture of CMT disease and physiological adaptations in pregnancy. In the second part of this paper we summarise specific results of two comparable studies on the obstetric history of women with CMT neuropathy in order to address the obstetric complication rate, newborn vitality, possible deterioration of CMT in or after pregnancy and personal attitudes. The results are based on two combined cohort studies with 21 and 54 participants.
Results:
We documented 148 pregnancies (129 deliveries), resulting in 131 infants. There were no increased complication rates in the recorded pregnancies. Miscarriage rate was 12.8 % and thus as high as in unaffected women. Deliveries were not associated with specific risks; there were no increased preterm deliveries, vaginal operations or caesarean sections, and no increased postpartum haemorrhages. Newborn vitality was normal and birth measurements were within the normal range. A deterioration of CMT related symptoms was reported in about one-third of the pregnancies and after delivery, however, the functional impact on everyday life was rather low in classical CMT. Most women expressed a positive attitude towards having own children and family life but those with a larger handicap would recommend medical advice and assistance in caring for the family.
Discussion and conclusion:
Pregnancy can be safely undertaken in women with classical CMT, despite the fact that a negative influence on the disease course appears possible. The data of a Norwegian study which found higher rates of presentation anomalies and operative deliveries and a higher risk of postpartum haemorrhage have not been confirmed in our study.
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Handberg C, Myrup P, Højberg AL. "I was worried about not being good enough". Experiences and perspectives on pregnancy, childbirth and parenthood when living with a neuromuscular disorder - an exploration of everyday life challenges. Disabil Rehabil 2020; 44:1821-1829. [PMID: 32805149 DOI: 10.1080/09638288.2020.1804628] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE The aim of this study was to explore the everyday life experiences and perspectives on challenges related to pregnancy, childbirth and parenthood when living with neuromuscular disorders (NMDs) and identify important elements to take into consideration for parents and their health professionals. MATERIALS AND METHODS In all, 27 people (17 with a NMD and 10 partners without a NMD) were included in this study. The participants were all parents or expecting parents. Both mothers and fathers and ambulant and non-ambulant participants were included to broaden the perspective. Three types of semi-structured interviews were applied. The analysis was guided by the Interpretive Description methodology and Antonovsky's Sense of Coherence theory. RESULTS The findings illuminated insights to ongoing challenges in the everyday lives of parents with NMD. Enforced Dilemmas represented guilt and dilemmas on the possibility of passing on the NMD. Reflections on Bodily Ability symbolized the effect that pregnancy and parenthood had on the body. Concept of Normality signified the concerns the parents had about "not being normal enough." Experience of Dependency addressed being dependent on others and No One to Emulate how the rarity of the NMD made it difficult to find peers or seek advice. CONCLUSION The study emphasizes the importance of the professionals providing counseling and support on pregnancy, childbirth, and parenthood either during consultations, online or in structured professional and peer-support rehabilitation groups for expecting parents or for new parents with a NMD.IMPLICATIONS FOR REHABILITATIONProfessionals must provide knowledge and counselling on pregnancy, childbirth, and parenthood to support families with NMD who are expecting a child or have already become parents and address the illusion of normal.Professional centralized and specialized units where people with NMD can get advice on pregnancy and give birth should be an option.Structured professional and peer-support rehabilitation groups (physical meetings or online) on pregnancy, childbirth, and parenthood may be of value for the parents due to the rarity of the diagnosis.Online information and knowledge on pregnancy, childbirth, and parenthood and NMD should be widely available.Health professionals and peers can help ensure and support an experience of comprehensibility, manageability, and meaningfulness among the parents with NMD and develop rehabilitation services that meet the needs and preferences of people considering getting a child or who are already parents with NMDs or other disabilities.
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Affiliation(s)
- C Handberg
- National Rehabilitation Center for Neuromuscular Diseases, Aarhus, Denmark.,Department of Public Health, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - P Myrup
- National Rehabilitation Center for Neuromuscular Diseases, Aarhus, Denmark
| | - A-L Højberg
- National Rehabilitation Center for Neuromuscular Diseases, Aarhus, Denmark
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Barghouthi T, Lemley R, Figurelle M, Bushnell C. Epidemiology of neurologic disease in pregnancy. HANDBOOK OF CLINICAL NEUROLOGY 2020; 171:119-141. [PMID: 32736746 DOI: 10.1016/b978-0-444-64239-4.00006-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Many neurologic diseases in women are influenced by the physiologic and hormonal changes of pregnancy, and pregnancy itself poses challenges in both treatment and evaluation of these conditions. Some diseases, such as epilepsy and multiple sclerosis, have a high enough prevalence in the young female population to support robust epidemiologic data while many other neurologic diseases, such as specific myopathies and muscular dystrophies, have a low prevalence, with data limited to case reports and small case series. This chapter features epidemiologic information regarding a breadth of neurologic conditions, including stroke, epilepsy, demyelinating disease, peripheral neuropathies, migraine, sleep-disordered breathing, and meningioma, in women in the preconception, pregnancy, and postpartum stages.
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Affiliation(s)
- Tamara Barghouthi
- Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, NC, United States
| | - Regan Lemley
- Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, NC, United States
| | - Morgan Figurelle
- Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, NC, United States
| | - Cheryl Bushnell
- Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, NC, United States.
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Stone J, Reed D. Maternal genetic diseases: potential concerns for mother and baby. Hum Genet 2019; 139:1173-1182. [PMID: 31729547 DOI: 10.1007/s00439-019-02086-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 10/29/2019] [Indexed: 12/14/2022]
Abstract
With advances in medical care, many women with genetic conditions previously known to decrease life expectancy are reaching childbearing age. Thus, it is important to understand the management of patients in the preconception, antepartum, and postpartum periods as they pose a unique challenge to the obstetrician. Most rare disorders lack well-established clinical guidelines for management in pregnancy. Existing data stem from case reports, case series, and expert opinion. We aim to summarize these recommendations and develop a clinical reference for managing reproductive age women with these conditions. We review recommendations for women with inborn errors in metabolism, connective tissue disorders, skeletal dysplasia, and selected single gene disorders. In all cases, it is crucial to employ a multidisciplinary team to optimize care for patients with rare disease before, during, and immediately after their pregnancies. The emphasis on expert consensus recommendations in the guidance of obstetric care is a signal that more studies are needed to determine best practices.
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Affiliation(s)
- Julie Stone
- Tufts Medical Center, 800 Washington Center, Boston, MA, 02111, USA
| | - Dallas Reed
- Tufts Medical Center, 800 Washington Center, Boston, MA, 02111, USA.
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10
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Abstract
The life expectancy and quality of life of women with genetic disorders continues to improve, resulting in more women reaching reproductive age and desiring fertility. It is becoming increasingly important that obstetricians become familiar with common genetic disorders and their associated risks in pregnancy. The authors review pregnancy in women with various genetic disorders, including review of pregnancy outcomes, management recommendations, and genetic risk assessment. Most data on pregnancies in women with genetic conditions are based on case reports and literature reviews. Additional studies, including pregnancy registries, are needed to improve our understanding and care of this patient population.
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Affiliation(s)
- Sarah Harris
- University of North Carolina at Chapel Hill School of Medicine, 3010 Old Clinic Building, CB 7516, Chapel Hill, NC 27516, USA
| | - Neeta L Vora
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, 3010 Old Clinic Building, CB 7516, Chapel Hill, NC 27516, USA.
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11
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Abati E, Corti S. Pregnancy outcomes in women with spinal muscular atrophy: A review. J Neurol Sci 2018; 388:50-60. [DOI: 10.1016/j.jns.2018.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 02/03/2018] [Accepted: 03/01/2018] [Indexed: 12/11/2022]
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12
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Holbeck-Brendel M, Poulsen BK. Treatment with enzyme replacement therapy during pregnancy in a patient with Pompe disease. Neuromuscul Disord 2017; 27:956-958. [DOI: 10.1016/j.nmd.2017.06.556] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 05/09/2017] [Accepted: 06/30/2017] [Indexed: 10/19/2022]
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Long-Bellil L, Mitra M, Iezzoni LI, Smeltzer SC, Smith L. The Impact of Physical Disability on Pregnancy and Childbirth. J Womens Health (Larchmt) 2017; 26:878-885. [PMID: 28661774 DOI: 10.1089/jwh.2016.6157] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Women with physical disabilities increasingly aspire to become pregnant and bear children. Limited information about the potential interaction of their disabling conditions with pregnancy and childbirth exists to guide these women and their clinicians. MATERIALS AND METHODS The interview guide was created with questions on topics such as pregnancy complications and secondary conditions, the impact of prior surgeries, experiences with pain relief during labor, and the impact on women's independence and participation in life activities. Interviews were conducted by telephone with 25 women with physical disabilities. They were subsequently transcribed verbatim and analyzed by using Atlas TI. RESULTS Women generally reported a relatively modest impact of disabling conditions on their pregnancies. Most women were satisfied with the mode of delivery, but they experienced challenges during the labor and delivery process. The women found that careful advanced planning was helpful in managing the impact of their disabling conditions. The involvement of clinicians with disability-related expertise was, in some cases, another factor that contributed to a positive outcome. CONCLUSIONS The importance of advanced planning and the utility of involving clinicians with disability-related expertise suggest that the use of integrated, interdisciplinary team approaches could promote quality care by facilitating improved planning and management. Additional clinical research is needed to provide women and their clinicians with more information on potential complications and options for labor and delivery.
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Affiliation(s)
- Linda Long-Bellil
- 1 Center for Health Policy and Research, Department of Family Medicine and Community Health, University of Massachusetts Medical School , Shrewsbury, Massachusetts
| | - Monika Mitra
- 2 Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University , Waltham, Massachusetts
| | - Lisa I Iezzoni
- 3 Mongan Institute for Health Policy , Massachusetts General Hospital, Boston, Massachusetts
- 4 Department of Medicine, Harvard Medical School , Boston, Massachusetts
| | - Suzanne C Smeltzer
- 5 Center for Nursing Research, Villanova University College of Nursing , Philadelphia, Pennsylvania
| | - Lauren Smith
- 2 Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University , Waltham, Massachusetts
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Horner-Johnson W, Biel FM, Darney BG, Caughey AB. Time trends in births and cesarean deliveries among women with disabilities. Disabil Health J 2017; 10:376-381. [PMID: 28431988 DOI: 10.1016/j.dhjo.2017.02.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 02/04/2017] [Accepted: 02/14/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Although it is likely that childbearing among women with disabilities is increasing, no empirical data have been published on changes over time in the numbers of women with disabilities giving birth. Further, while it is known that women with disabilities are at increased risk of cesarean delivery, temporal trends in cesarean deliveries among women with disabilities have not been examined. OBJECTIVE To assess time trends in births by any mode and in primary cesarean deliveries among women with physical, sensory, or intellectual/developmental disabilities. METHODS We conducted a retrospective cohort study using linked vital records and hospital discharge data from all deliveries in California, 2000-2010 (n = 4,605,061). We identified women with potential disabilities using ICD-9 codes. We used descriptive statistics and visualizations to examine time patterns. Logistic regression analyses assessed the association between disability and primary cesarean delivery, stratified by year. RESULTS Among all women giving birth, the proportion with a disability increased from 0.27% in 2000 to 0.80% in 2010. Women with disabilities had significantly elevated odds of primary cesarean delivery in each year, but the magnitude of the odds ratio decreased over time from 2.60 (95% CI = 2.25 = 2.99) in 2000 to 1.66 (95% CI = 1.51-1.81) in 2010. CONCLUSION Adequate clinician training is needed to address the perinatal care needs of the increasing numbers of women with disabilities giving birth. Continued efforts to understand cesarean delivery patterns and reasons for cesarean deliveries may help guide further reductions in proportions of cesarean deliveries among women with disabilities relative to women without disabilities.
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Affiliation(s)
- Willi Horner-Johnson
- Institute on Development and Disability, Oregon Health & Science University, Portland, OR, USA.
| | - Frances M Biel
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, USA
| | - Blair G Darney
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, USA; National Institute of Public Health, Center for Health Systems Research, Cuernavaca, Mexico
| | - Aaron B Caughey
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, USA
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Long-Bellil L, Mitra M, Iezzoni LI, Smeltzer SC, Smith LD. Experiences and unmet needs of women with physical disabilities for pain relief during labor and delivery. Disabil Health J 2017; 10:440-444. [PMID: 28428112 DOI: 10.1016/j.dhjo.2017.02.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 01/24/2017] [Accepted: 02/19/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Childbirth is widely acknowledged as one of the most painful experiences most women will undergo in their lifetimes. Alleviating labor and delivery pain for women with physical disabilities can involve an additional level of complexity beyond that experienced by most women, but little research has explored their experiences. OBJECTIVE The purpose of this study was to explore the experiences of women with physical disabilities with respect to pain relief during labor and delivery with the goal of informing their care. METHODS Data were collected using semi-structured interviews with twenty-five women with physical disabilities from across the United States. RESULTS Women expressed specific preferences for the method of pain relief. Some confronted systemic barriers in exploring their options for pain relief, while others were given a choice. At times, anesthesiologists lacked knowledge and experience in caring for women with disabilities. Conversely, some women described how the administration of anesthesia was meticulously planned and attributed their positive labor and delivery experiences to this careful planning. CONCLUSIONS Advanced, individualized planning and evaluation of their options for pain relief was most satisfying to women and enabled them to make an informed choice. This approach is consistent with the recommendations of clinicians who have successfully provided pain relief during labor to women with complex physical disabilities. Clinicians who have successfully delivered babies of women with these and similar disabilities emphasize the importance of a team approach where the anesthesiologist and other specialists are involved early on in a woman's care.
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Affiliation(s)
- Linda Long-Bellil
- Center for Health Policy and Research, University of Massachusetts Medical School, 333 South Street, Shrewsbury, MA, 01545, United States.
| | - Monika Mitra
- Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA, 02453, United States.
| | - Lisa I Iezzoni
- Harvard Medical School, The Mongan Institute for Health Policy, Massachusetts General Hospital, 50 Staniford Street, Room 901B, Boston, MA, 02114, United States.
| | - Suzanne C Smeltzer
- Center for Nursing Research, Villanova University College of Nursing, 800 Lancaster Avenue, Villanova, PA, 190895, United States.
| | - Lauren D Smith
- The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA, 02453, United States.
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Elsheikh BH, Zhang X, Swoboda KJ, Chelnick S, Reyna SP, Kolb SJ, Kissel JT. Pregnancy and delivery in women with spinal muscular atrophy. Int J Neurosci 2017; 127:953-957. [PMID: 28102719 DOI: 10.1080/00207454.2017.1281273] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To expand the limited available knowledge about pregnancy and delivery in women with spinal muscular atrophy (SMA) using a cohort of genetically proven SMA patients from USA. METHODS This was a cross-sectional questionnaire-based study. We mailed questionnaires to 58 women with confirmed SMA. RESULTS Thirty-two women responded, reporting 35 pregnancies, including 19 women with at least one pregnancy. In this cohort, preterm labor and delivery by cesarean section were more common in mothers with SMA particularly SMA type 2. Seventy-four percent of mothers reported increased weakness during pregnancy that persisted after delivery in 42%. SMA mothers generally had a positive experience and good outcomes and elected to have more than one pregnancy. CONCLUSION This information regarding pregnancy in women with genetically confirmed 5q SMA will prove useful in guiding future research and in providing counseling to women with SMA.
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Affiliation(s)
- Bakri H Elsheikh
- a Neurology , Johns Hopkins Aramco Healthcare , Dhahran , Saudi Arabia
| | - Xiaoli Zhang
- b Center for Biostatistics , The Ohio State University Wexner Medical Center , Columbus , OH , USA
| | - Kathryn J Swoboda
- c Department of Neurology , Massachusetts General Hospital , Boston , MA , USA
| | - Sharon Chelnick
- d Department of Neurology , The Ohio State University Wexner Medical Center, Columbus , OH , USA
| | - Sandra P Reyna
- e Neurology Clinical Research Institute , Massachusetts General Hospital , Boston , MA , USA
| | - Stephen J Kolb
- d Department of Neurology , The Ohio State University Wexner Medical Center, Columbus , OH , USA
| | - John T Kissel
- d Department of Neurology , The Ohio State University Wexner Medical Center, Columbus , OH , USA
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Darney BG, Biel FM, Quigley BP, Caughey AB, Horner-Johnson W. Primary Cesarean Delivery Patterns among Women with Physical, Sensory, or Intellectual Disabilities. Womens Health Issues 2017; 27:336-344. [PMID: 28109562 DOI: 10.1016/j.whi.2016.12.007] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 12/15/2016] [Accepted: 12/16/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND Little is known about the relationship between disability and mode of delivery. Prior research has indicated elevated risk of cesarean delivery among women with certain disabilities, but has not examined patterns across multiple types of disability or by parity. OBJECTIVE This study sought to determine whether physical, sensory, or intellectual and developmental disabilities are independently associated with primary cesarean delivery. METHODS We conducted a retrospective cohort study of all deliveries in California from 2000 to 2010 using linked birth certificate and hospital discharge data. We identified physical, sensory, and intellectual and developmental disabilities using International Classification of Diseases, 9th revision, clinical modification codes. We used logistic regression to examine the association of these disabilities and primary cesarean delivery, controlling for sociodemographic characteristics and comorbidities, and stratified by parity. RESULTS In our sample, 0.45% of deliveries (20,894/4,610,955) were to women with disabilities. A greater proportion of women with disabilities were nulliparous, had public insurance, and had comorbidities (e.g., gestational diabetes) compared with women without disabilities (p < .001 for all). The proportion of primary cesarean in women with disabilities was twice that in women without disabilities (32.7% vs. 16.3%; p < .001; adjusted odds ratio, 2.05; 95% confidence interval, 1.94-2.17). The proportion of deliveries by cesarean was highest among women with physical disabilities due to injuries compared with women without disabilities (57.8% vs. 16.3%; p < .001; adjusted odds ratio, 6.83; 95% confidence interval, 5.46-8.53). CONCLUSIONS Women across disability subgroups have higher odds of cesarean delivery, and there is heterogeneity by disability type. More attention is needed to this population to ensure better understanding of care practices that may impact maternal and perinatal outcomes.
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Affiliation(s)
- Blair G Darney
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon; National Institute of Public Health, Center for Health Systems Research, Cuernavaca, Mexico
| | - Frances M Biel
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon
| | - Brian P Quigley
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon
| | - Aaron B Caughey
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon
| | - Willi Horner-Johnson
- Institute on Development and Disability, Oregon Health & Science University, Portland, Oregon.
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Hori H, Maeda Y, Ishizaki M, Hirahara T, Watanabe M, Yamashita S, Yamashita T, Uchino M, Ando Y. A carrier with de novo
Mutation in the dystrophin gene whose myopathic symptoms became seriously progressive after pregnancy and delivery. Muscle Nerve 2015; 52:913-4. [DOI: 10.1002/mus.24744] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 06/12/2015] [Accepted: 06/16/2015] [Indexed: 11/12/2022]
Affiliation(s)
- Hiroko Hori
- Department of Neurology; Graduate School of Medical Sciences, Kumamoto University; Kumamoto Japan
| | - Yasushi Maeda
- Department of Neurology; Graduate School of Medical Sciences, Kumamoto University; Kumamoto Japan
| | - Masatoshi Ishizaki
- Department of Neurology; Graduate School of Medical Sciences, Kumamoto University; Kumamoto Japan
| | - Tomoo Hirahara
- Department of Neurology; Graduate School of Medical Sciences, Kumamoto University; Kumamoto Japan
| | - Masaki Watanabe
- Department of Neurology; Graduate School of Medical Sciences, Kumamoto University; Kumamoto Japan
| | - Satoshi Yamashita
- Department of Neurology; Graduate School of Medical Sciences, Kumamoto University; Kumamoto Japan
| | - Taro Yamashita
- Department of Neurology; Graduate School of Medical Sciences, Kumamoto University; Kumamoto Japan
| | - Makoto Uchino
- Department of Neurology; Graduate School of Medical Sciences, Kumamoto University; Kumamoto Japan
| | - Yukio Ando
- Department of Neurology; Graduate School of Medical Sciences, Kumamoto University; Kumamoto Japan
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Rakocevic-Stojanovic V, Peric S, Basta I, Dobricic V, Ralic V, Kacar A, Peric M, Novakovic I. Variability of multisystemic features in myotonic dystrophy type 1--lessons from Serbian registry. Neurol Res 2015; 37:939-44. [PMID: 26184384 DOI: 10.1179/1743132815y.0000000068] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Myotonic dystrophy type 1 (DM1) is a rare disease. Creating registry for such a disease is of outstanding importance since it provides us with a full spectrum of the disorder. AIM To assess variability of different multisystemic features in a large cohort of patients with DM1. PATIENTS AND METHOD Data from the Serbian registry for myotonic dystrophies were used in the study. Final number of included DM1 subjects was 275. RESULTS Registry included 53.8% of male patients. Age at enrollment was 47.2 ± 9.9 years, mean disease duration 20.4 ± 9.9 years, and mean CTG repeats number 598.3 ± 269.8.Progression of muscle weakness was pretty slow, slower in proximal than distal muscles, and slower in arms than in legs. Severe ECG abnormality was found in 25.0% of patients and pacemaker was implanted in 9.5%. Lens opacities were observed in 83.5% of DM1 patients and 35.3% had ocular hypotony. Metabolic disturbances were very common, while 19.5% of patients had hypokalemia and 37.8% hypochloremia. Sterility was found in 20.5% of males and 4.1% of females. Cholelithiasis was found in 36.4% of patients and constipation in 29.9%. CONCLUSIONS We defined the most common characteristics of our DM1 patients and observed some treatable symptoms that have been neglected previously. Certain findings deserve further investigations in terms of their causes and consequences. Besides this, presented data analysis directs us to make further improvements of the registry.
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Matsumura T, Kimura T, Kokunai Y, Nakamori M, Ogata K, Fujimura H, Takahashi MP, Mochizuki H, Sakoda S. Simple questionnaire for screening patients with myotonic dystrophy type 1. ACTA ACUST UNITED AC 2014. [DOI: 10.1111/ncn3.93] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Tsuyoshi Matsumura
- Department of Neurology; National Hospital Organization Toneyama National Hospital; Toyonaka Japan
| | - Takashi Kimura
- Division of Neurology; Department of Internal Medicine; Hyogo Medical College of Medicine; Nishinomiya Japan
| | - Yosuke Kokunai
- Department of Neurology; Osaka University Graduate School of Medicine; Suita Japan
| | - Masayuki Nakamori
- Department of Neurology; Osaka University Graduate School of Medicine; Suita Japan
| | - Katsuhisa Ogata
- Department of Neurology; National Hospital Organization Higashisaitama Hospital; Hasuda Japan
| | - Harutoshi Fujimura
- Department of Neurology; National Hospital Organization Toneyama National Hospital; Toyonaka Japan
| | - Masanori P Takahashi
- Department of Neurology; Osaka University Graduate School of Medicine; Suita Japan
| | - Hideki Mochizuki
- Department of Neurology; Osaka University Graduate School of Medicine; Suita Japan
| | - Saburo Sakoda
- Department of Neurology; National Hospital Organization Toneyama National Hospital; Toyonaka Japan
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Karabul N, Berndt J, Kornblum C, Kley RA, Wenninger S, Tiling N, Mengel E, Plöckinger U, Vorgerd M, Deschauer M, Schoser B, Hanisch F. Pregnancy and delivery in women with Pompe disease. Mol Genet Metab 2014; 112:148-53. [PMID: 24726296 DOI: 10.1016/j.ymgme.2014.03.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 03/24/2014] [Accepted: 03/24/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND The obstetric risk in patients with Pompe disease (glycogen storage disease type II), a mainly skeletal muscle disorder, is unknown. METHODS The clinical course and the outcome of pregnancy, and the effect of pregnancy on disease manifestations or clinical signs and symptoms in Pompe disease were analyzed retrospectively using a questionnaire. Participating women with Pompe disease were recruited by the German and the UK sections of the International Pompe Association, and by centers associated within the German Pompe Group. The data was compared with information from the German statistical almanac, perinatal registry, and perinatal quality survey. RESULTS 66 of 136 women responded to the questionnaire (median age: 47 years, range: 18-74). In 10 of 52 women who had been pregnant, the symptoms of Pompe disease were present during pregnancy (n=7 1st, n=1 2nd, n=1 3rd pregnancy). Muscle weakness worsened in 3 women, and first presented in 3 others during the first pregnancy (4.5% each). Respiratory problems deteriorated in 2/10 women during pregnancy. These 10 symptomatic women had 17 pregnancies (15 deliveries, 2 miscarriages, no abortions). The 42 asymptomatic women (63.6%) had 109 pregnancies (72.4% deliveries, 19.3% miscarriages, 7.3% abortions). There were no significant differences between the mean duration of pregnancies or the mean birth weight in symptomatic and asymptomatic women, or compared to the data from the general population. The same was true of pregnancy and delivery complications (including Cesarean section). CONCLUSIONS Our data show that women with Pompe disease do not appear to have an increased risk of pregnancy or delivery complications. However, muscle weakness and respiratory complications might manifest or worsen during pregnancy in some women.
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Affiliation(s)
- Nesrin Karabul
- Villa Metabolica, Centre for Pediatric and Adolescent Medicine, Langenbeckstr. 2, 55131 Mainz, Germany
| | - Janine Berndt
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany
| | | | - Rudolf A Kley
- Department of Neurology, Neuromuscular Centre Ruhrgebiet, University Hospital Bergmannsheil, Ruhr-University Bochum, Buerkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
| | - S Wenninger
- Friedrich-Baur Institute, Department of Neurology, Ludwig-Maximilians University Munich, Munich, Germany
| | - Nikolaus Tiling
- Kompetenzzentrum Seltene Stoffwechselkrankheiten, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Eugen Mengel
- Villa Metabolica, Centre for Pediatric and Adolescent Medicine, Langenbeckstr. 2, 55131 Mainz, Germany
| | - Ursula Plöckinger
- Kompetenzzentrum Seltene Stoffwechselkrankheiten, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Matthias Vorgerd
- Department of Neurology, Neuromuscular Centre Ruhrgebiet, University Hospital Bergmannsheil, Ruhr-University Bochum, Buerkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
| | - Marcus Deschauer
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany
| | - Benedikt Schoser
- Friedrich-Baur Institute, Department of Neurology, Ludwig-Maximilians University Munich, Munich, Germany
| | - Frank Hanisch
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany.
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Schwangerschaftsverlauf und geburtshilfliche Risiken bei 178 Frauen mit hereditären neuromuskulären Erkrankungen. MED GENET-BERLIN 2013. [DOI: 10.1007/s11825-013-0410-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Zusammenfassung
Hintergrund
Informationen zu Schwangerschaft und Entbindung bei Frauen mit hereditären neuromuskulären Erkrankungen (NMD) sind aufgrund der Seltenheit meist auf kleine Fallserien und Kasuistiken beschränkt.
Ziel der Arbeit
Die Frage, ob erhöhte geburtshilfliche Risiken und eine mögliche Beeinflussung des Krankheitsverlaufes bestehen, ist auch für die genetische Beratung von großer Bedeutung und soll in der vorliegenden Studie untersucht werden.
Methode
Die Schwangerschaftsverläufe von Frauen mit myotoner Dystrophie Typ 1 (DM1) und Typ 2 (DM2), Charcot-Marie-Tooth-Neuropathie (CMT), proximaler spinaler Muskelatrophie (SMA), Gliedergürtelmuskeldystrophie (LGMD), fazioskapulohumeraler Muskeldystrophie (FSHD) und kongenitaler Myopathie (CM) wurden retrospektiv untersucht. Es wurden 380 Schwangerschaften mit 315 Neugeborenen von 178 Patientinnen dokumentiert.
Ergebnisse und Schlussfolgerung
Die Fehlgeburtenrate war im Normbereich. Frühgeburten, vaginale Operation und Kaiserschnitte stellten v. a. bei DM1 und SMA wichtige Komplikationen dar, während fetale Lageanomalien gehäuft bei DM1, LGMD und rollstuhlpflichtigen Patientinnen auftraten. Abgesehen von DM1-Geburten mit kongenitaler Form war der Gesundheitszustand der Neugeborenen gut. Eine erhebliche Verschlechterung während der Schwangerschaft gaben insbesondere Frauen mit LGMD an.
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Bethlem myopathy: pregnancy and delivery. Arch Gynecol Obstet 2013; 289:219-20. [DOI: 10.1007/s00404-013-2942-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 06/26/2013] [Indexed: 10/26/2022]
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Abstract
Neuromuscular diseases can have a tremendous impact on pregnant women and affect offspring. Healthcare providers need to have a firm understanding of the genetics involved as well as the potential complications that can arise when treating pregnant women who have been diagnosed with a neuromuscular disease or have an increased risk for delivering an infant affected by one of these disorders. This article provides a comprehensive synopsis of genetics, including the strategies for obtaining a detailed patient and family genetic history through construction of a pedigree, as well as imparting some key knowledge for providing appropriate counseling and treatment to affected individuals and families. It addresses the genetic testing, diagnosis, impact, and medical considerations for both patients and offspring affected by myotonic dystrophy, Duchenne and Becker muscular dystrophies, limb-girdle muscular dystrophy, Charcot-Marie-Tooth disease, and spinal muscular atrophy.
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Zagnoli F, Leblanc A, Blanchard C. Pregnancy during enzyme replacement therapy for late-onset acid maltase deficiency. Neuromuscul Disord 2013; 23:180-1. [PMID: 23290485 DOI: 10.1016/j.nmd.2012.11.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Revised: 11/04/2012] [Accepted: 11/07/2012] [Indexed: 10/27/2022]
Abstract
We report the case of a female patient who developed Pompe's disease when she was 19. She received enzyme replacement therapy from the age of 35, and after three years of treatment the improvement in her clinical condition was such that she was able to consider having a baby. It was the patient's wishes to continue with her treatment throughout the entirety of her pregnancy. There were no complications, but there was a clear deterioration in motor and respiratory functions. She delivered at term by Caesarean section, and the child was healthy. Six months later, we noted an improvement of her motor and respiratory functions. The child was developing normally.
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Affiliation(s)
- Fabien Zagnoli
- Hôpital Clermont Tonnerre, rue Fonferrier, 29200 Brest, France.
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Management of pregnancy in women with genetic disorders, Part 1: Disorders of the connective tissue, muscle, vascular, and skeletal systems. Obstet Gynecol Surv 2012; 66:699-709. [PMID: 22186601 DOI: 10.1097/ogx.0b013e31823cdd50] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
UNLABELLED Due to early diagnosis and increasingly effective medical advances, the number of women with various genetic syndromes who are undergoing pregnancy is increasing, and this represents an important issue for providers of obstetric care. Each year more women with genetic disease reach childbearing age. Advances in assisted reproductive technology have enabled pregnancy in a cohort of woman who may experience impaired fertility due to their underlying diagnosis. Management of these women requires coordination of care by healthcare providers from multiple specialties to optimize outcomes. Potentially serious medical issues specific to each diagnosis often exist in the preconception, antepartum, intrapartum, and postpartum periods, all of which must be recognized to allow timely diagnosis and treatment. The fetus may also face issues related to risk for inheritance of the genetic disorder itself, as well as risks related to the chronic disease status of the mother. This article will explore the issues faced by women with various genetic disorders that may affect connective tissue, muscular, vascular, and skeletal systems. TARGET AUDIENCE Obstetricians & Gynecologists and Family Physicians. LEARNING OBJECTIVES After the completing the CME activity, physicians should be better able to classify the cardiovascular manifestations observed in Marfan syndrome and Ehlers-Danlos, evaluate prenatal diagnostic options and limitations for various genetic syndromes, assess the risks to the fetus in women with various genetic syndromes. Determine whether there is a preferred mode of delivery for pregnant patients with various genetic syndromes described in this paper.
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Awater C, Zerres K, Rudnik-Schöneborn S. Pregnancy course and outcome in women with hereditary neuromuscular disorders: comparison of obstetric risks in 178 patients. Eur J Obstet Gynecol Reprod Biol 2012; 162:153-9. [PMID: 22459654 DOI: 10.1016/j.ejogrb.2012.02.020] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2011] [Revised: 01/27/2012] [Accepted: 02/20/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Information about pregnancy and delivery in hereditary neuromuscular disorders (NMD) is limited and largely restricted to small case series and single case reports. Further data of obstetric histories in clinically and genetically defined subgroups are required. STUDY DESIGN We reviewed the obstetric histories of 178 patients with myotonic dystrophy type 1 (DM1) and 2 (DM2), Charcot-Marie-Tooth disease (CMT), spinal muscular atrophy (SMA), limb-girdle muscular dystrophy (LGMD), facioscapulohumeral muscular dystrophy (FSHD), and congenital myopathy (CM) by means of questionnaires and medical reports. Patients were recruited in the period 1992-2010 after they had at least completed one pregnancy. A total of 380 pregnancies resulting in 315 children were documented. RESULTS Compared to the normal German population, the number of miscarriages and hypertensive diseases in pregnancy was not increased in the cohort. Patients with NMD delivered more frequently by vaginal operations (8.9-18.2%) and by cesarean births with significantly high rates in DM1 (36.7%) and SMA (42.4%). Preterm deliveries were recorded in 30.7% of DM1, 12.6% of DM2, and 29.4% of SMA gestations. Abnormal fetal presentation occurred significantly more frequently in DM1 (34.6%) and LGMD (26.7%) deliveries and was a feature of chairbound patients. Considering a possible influence of pregnancy on the disease course, about half of LGMD, one-third of SMA, and one fifth of CMT patients reported a deterioration of symptoms in pregnancy. Neonatal outcome was favorable in all NMD but DM1, where infantile morbidity and mortality is often but not exclusively related to congenitally affected children. CONCLUSION Our data are important for obstetric care and genetic counseling of women with NMD who are contemplating pregnancy.
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Affiliation(s)
- Carina Awater
- Institute of Human Genetics, Medical Faculty, RWTH Aachen, Germany
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Schwere Muskeldystrophie und Schwangerschaft. Anaesthesist 2011; 61:52-5. [DOI: 10.1007/s00101-011-1938-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Revised: 08/14/2011] [Accepted: 08/15/2011] [Indexed: 12/15/2022]
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Norwood F, Rudnik-Schöneborn S. 179th ENMC international workshop: pregnancy in women with neuromuscular disorders 5-7 November 2010, Naarden, The Netherlands. Neuromuscul Disord 2011; 22:183-90. [PMID: 21689937 DOI: 10.1016/j.nmd.2011.05.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2011] [Indexed: 10/18/2022]
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Lemos A, Souza AI, Andrade ADD, Figueiroa JN, Cabral-Filho JE. Força muscular respiratória: comparação entre primigestas e nuligestas. J Bras Pneumol 2011; 37:193-9. [DOI: 10.1590/s1806-37132011000200009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Accepted: 01/11/2011] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Descrever e comparar os valores de PImáx e de PEmáx em primigestas e nuligestas na faixa etária de 20-29 anos pareadas por idade. MÉTODOS: Foram estudadas 120 primigestas de baixo risco obstétrico, da 5ª a 40ª semana gestacional, e 40 nuligestas, eutróficas, não praticantes de atividade física, provenientes da região metropolitana do Recife (PE). Os valores de PImáx e PEmáx foram obtidos, respectivamente, a partir do VR e da CPT através de um manovacuômetro digital. A comparação entre os grupos foi feita pelo teste t de Student, e a relação dos fatores grupo e idade cronológica sobre as pressões foi avaliada através de regressão linear múltipla. RESULTADOS: No grupo de primigestas e nuligestas, a média de PImáx foi de, respectivamente, 88,5 ± 16,52 cmH2O e 94,22 ± 22,63 cmH2O (p = 0,08), enquanto a média de PEmáx foi de 99.76 ± 18,19 cmH2O e 98,67 ± 20,78 cmH2O (p = 0,75). Não houve correlação entre a idade gestacional e PImáx (r = -0,06; p = 0,49) ou PEmáx (r = -0,11; p = 0,22). A relação entre idade cronológica e PImáx/PEmáx não diferiu entre primigestas e nuligestas (coeficiente angular = 0,028 e 0,453, respectivamente). CONCLUSÕES: As pressões respiratórias de mulheres primigestas mantiveram-se estáveis durante o ciclo gestacional e não diferem significativamente dos valores das nuligestas na faixa etária de 20-29 anos.
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Howarth L, Glanville T. Management of a pregnancy complicated by type III spinal muscular atrophy. BMJ Case Rep 2011; 2011:2011/feb17_1/bcr1020103402. [PMID: 22707496 DOI: 10.1136/bcr.10.2010.3402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The authors report the successful management of a pregnancy in a patient with spinal muscular atrophy (SMA) type III. It is a genetically inherited condition causing increasing weakness of the skeletal muscle. The patient in our case was confined to a wheelchair due to marked weakness in her lower limbs. A review of the available literature identified potential risk factors for the antenatal, intrapartum and postpartum period. These include increased risk of thromboembolism, urinary tract infections, intrauterine growth restriction and preterm delivery, anaesthetic problems and increased risk of uterine atony with subsequent postpartum haemorrhage. The authors report the management of these risk factors and the reasons for delivery by Caesarean section at 32 weeks. Apart from a decline in muscle function postdelivery requiring physiotherapy, there were no adverse outcomes for mother or baby. In both this case and on review of the literature, it is proven that a successful pregnancy is possible with SMA.
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Affiliation(s)
- L Howarth
- Department of Obstetrics and Gynaecology, St James's University Hospital, Leeds, West Yorkshire, UK.
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Kuczkowski KM, Fernández CL, Drobnik L, Chandra S. Anesthesia for cesarean section in a parturient with Charcot-Marie-Tooth disease: unresolved controversies. Arch Gynecol Obstet 2010; 282:347-8. [PMID: 20229081 DOI: 10.1007/s00404-010-1417-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2010] [Accepted: 02/25/2010] [Indexed: 11/24/2022]
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