Amyotrophic lateral sclerosis in pregnancy

Amyotrophic lateral sclerosis is rare in the obstetric population; only one case has been described in the last 18 years. Two pregnant women with this disease were observed within a 1-year period in Minneapolis.

A twin pregnancy was diagnosed in a woman during hospital admission for evaluation of a pure lower motor neuron degenerative process. The disease was rapidly progressive, with maternal death occurring 6 weeks after the delivery of healthy twins at 34 weeks' gestation. A second patient with amyotrophic lateral sclerosis conceived in the early stages of respirator dependency; her disease remained stable throughout the pregnancy, and she delivered at 33 weeks. The neonates had a good outcome in both cases.

Amyotrophic lateral sclerosis, though rare in pregnancy, does occur and can result in good neonatal outcome. Maternal disease does not regress during pregnancy and may worsen under the increased respiratory and weight-bearing demands; whether this represents actual disease progression cannot be determined definitely. Labor management should include pulse oximetry determination and is facilitated by lack of disease involvement of the uterine sensory and motor nerves and a lack of resistance of the pelvic floor musculature.