Muscular dystrophy is the name given to a group of genetic conditions characterized by progressive muscle weakness and wasting. Reduced muscle strength in women with such disorders can cause complications during pregnancy and childbirth.
Muscular dystrophy and pregnancy
It is essential that women discuss the potential complications of pregnancy with their medical team (primary care doctor, neurologist, cardiologist, pulmonologist, obstetrician, anesthesiologist, pediatrician, etc.) to prepare for such eventualities.
Added weight due to the growth of the fetus contributes to muscle weakness; women may have to use a wheelchair toward the end of their pregnancy. Limited mobility can aggravate the symptoms of muscle weakness in these patients.
Pregnancy can also worsen breathing in muscular dystrophy patients who have poor lung function. The muscles in the abdomen support breathing and weakening of those muscles already causes reduced breathing capacity, which can be compounded by the enlarging abdomen.
In patients with heart involvement, pregnancy can cause further complications. Excess fluid due to pregnancy and the extra weight can force the heart to work harder, putting extra strain on it.
Scoliosis and contractures can make pregnancy difficult, and add strain on the heart and lungs to sustain both mother and child as the pregnancy progresses.
Women with myotonic dystrophy are at greater risk of complications associated with pregnancy. Most muscular dystrophies affect the voluntary muscles, such as those in the hands, face, and head, as well as the muscles used for breathing and swallowing. In myotonic dystrophy patients, involuntary or smooth muscles on the linings of the gastrointestinal tract, vagina, uterus, and urinary tract are also involved. Abnormalities in the muscles in the womb and vagina can increase the risk of miscarriage, heavy bleeding, premature labor due to excess fluid around the baby, and retention of the placenta. Changes in body composition due to pregnancy increase the chances of diabetes and other complications. If the baby is diagnosed with congenital muscular dystrophy, pregnancy-associated complications become more evident.
Facioscapulohumeral muscular dystrophy (FSHD) usually manifests in women around childbearing age. Although limited information is available about the impact of muscle weakness in women with FSDH, there is a markedly higher risk of low birth weight in babies born to women with FSHD.
Muscular dystrophy and labor
There are three stages of labor, and muscular dystrophy affects each stage differently.
In the first stage, the neck of the uterus (cervix) dilates in preparation for delivery. This stage involves the involuntary smooth muscles of the uterus (uterine muscles). Because most muscles affected by muscular dystrophy are voluntary muscles (except for myotonic muscular dystrophy), most patients do not have any difficulty during this stage of labor.
In the second stage of labor, the uterine muscles continue to contract. However, this stage also requires the voluntary muscles of the abdomen to help push the baby out. The voluntary muscles of the abdomen are weak in muscular dystrophy patients and can make pushing difficult, prolonging labor. In such cases, assisted labor and delivery with the help of forceps or vacuum assist may be required, especially in patients with myotonic dystrophy. In anticipation of such issues, some patients may opt for cesarean delivery.
The third stage of labor is after the baby has been delivered and it is time for delivery of the placenta. It involves some effort from the patient while small contractions help deliver the placenta. Usually, this stage is not tiring, but some patients may experience complications associated with incomplete delivery of the placenta.
Muscular dystrophy and anesthesia
Muscular dystrophy patients are at increased risk of complications in the use of general anesthesia. Therefore, epidural anesthesia is preferred over general anesthesia in such patients.
All muscular dystrophy patients are at a higher risk of developing chest infections following general anesthesia.
Other points to consider
Once the baby is born, many duties must be performed to care for the child in the years to come. People with muscular dystrophy may have difficulty holding and caring for the baby because of muscle weakness in the upper body. Physical and psychological help may be warranted for such patients.
Muscular Dystrophy News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare providers with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.