Pregnancy in

Amyotrophic Lateral Sclerosis

Prabaningrum Widyasmoro Prasetyanti
Lecturer: Prof. Dr. M. I. Widiastuti, PAK, Sp.S(K), M.Sc

Introduction
ALS CARE Database:

60% are men (1,5-2:1),

Between 40 to 70 years of age
Rare in the obstetric population.
Potentially dangerous event.
Pregnancy & delivery may be normal, but
respiratory function should be carefully monitored.
Pregnancies, early-stage: develop normally,
uncomplicated vaginal delivery.
Pregnancies, late stages: critical for mother &
child, early delivery by SC may become
necessary, neonatal outcome can be good.

Epidemiology
Largest report (1956) in Guam: 21 pregnancies,

17 women with ALS.

12 in English language literature since 1977: 5
diagnosed before pregnancy, 8 diagnosed during
pregnancy.
No deaths due to neurological complications:
1 therapeutic abortion (severe dyspnoea),
4 delivery by SC (worsening maternal condition)
3 post-natal death,
5 pre-term deliveries (1 due to PROM, 4 by
worsening maternal condition).

The choice of vaginal or cesarean section

controversial.
Uterine muscle is not affected, do not concern
of uterine inertia.
Sensation (+): patient would not have any
difficulty in perceiving uterine contractions.
Labour progressed smoothly until cervical
dilatation complete, but the patient could not
push down fully, & became fatigued.

ALS diaphragm & costal muscles involved cant

increase ventilation appropriately Oxygen

therapy, blood gas monitoring before labour, &
respiratory support indicated during labour.
40-50% increase in the resting minute ventilation
rise in tidal volume rather than respiratory rate.
Late in pregnancy: diaphragmatic elevation caused
by enlarging uterus decrease functional residual
capacity increasing breathing difficulties.
If patient is in respiratory failure: indication for CS.

Regional anesthesia (RA): provide sustained

pain relief, preserve bulbar function,

greater potential for earlier establishment
of mother-child bonding,
RA & GA: similar reductions in lung volume
and flow rates.
There seem to be no contraindication for
vaginal delivery and epidural analgesia
seems to be well tolerated

The fetal growth normal, intrauterine

environment healthy, neonatal weight

satisfactory for the gestational age.
No adverse effect of ALS on the fetus, even
in advanced cases, neonatai outcome is
good in ALS.
Pregnancy with ALS does not cause
obstetric complications, but may limit
maternal survival and reduce maternal
quality of life.

Riluzole categorized as class C in the FDA

classification.
The drug had no side effects for mother
and baby, and was able to keep the
pregnancy stable.

Thank You