Two consecutive pregnancies in early and late stage of amyotrophiclateral sclerosis

摘要

There are few reports on pregnancies in sporadic and familial amyotrophic lateral sclerosis (ALS). We report on a youngwoman with sporadic ALS who gave birth twice during the course of her disease. The first pregnancy occurred 13 monthsafter the onset of symptoms, and one month after diagnosis. The pregnancy was uncomplicated and resulted in vaginaldelivery of a healthy boy. Fifteen months later, when she was already bed-ridden, she became pregnant again. She receiveda percutaneous endoscopic gastrostomy in the 21st gestational week and underwent early Caesarean section in the 34thweek of gestation. The child was ventilated for 72 h in a neonatological unit. The patient was tracheotomized andventilated two months later, i.e. 47 months after symptom onset, and died nine months later from gastrointestinalhaemorrhage. Her two children have developed without abnormalities to date. This case confirms that pregnancies inearly-stage ALS can develop normally and may result in uncomplicated vaginal delivery. Pregnancies in late stages may becritical for mother and child, and early delivery by Caesarean section may become necessary although neonatal outcomecan be good.