In women diagnosed with Charcot-Marie-Tooth (CMT), the course of pregnancy and delivery outcomes were not significantly different from the general population, according to study results published in Neurology.
The aim of this study was to elucidate the complications of pregnancy and delivery in CMT and the course of the disease during pregnancy.
Using the Italian national CMT registry and an ad hoc online questionnaire, the study researchers retrospectively collected data on the frequency of pregnancies and delivery outcomes from 139 patients with CMT and 31 age-matched control patients and the Italian population. Of these, 93 patients with CMT disease and 24 patients in the control group became pregnant between 1960 and 2015.
The data contained detailed information on the pregnancy course from questionnaires completed by 86 women with CMT (ages 20-73 years; 193 pregnancies and 157 deliveries) [81.4%] with 163 newborns) and 24 controls (59 pregnancies and 46 deliveries).
Demographic and clinical information on women with CMT disease and control patients showed no significant differences in the pregnancy rate in women (1.6 versus 1.9), mean age at pregnancy (28.7 versus 29.5 years), or mean Week of pregnancy at delivery (38.6 vs 38.9 weeks).
In terms of pregnancy outcomes and complications, the data showed miscarriages in 22 of 193 pregnancies (11.4%) with CMT disease; The rate was similar in the reference population (9.6%), but increased in the controls (9 of 59 women) [15.3%]). The voluntary abortion rate was similar in women with CMT and controls (7.3% versus 6.8%) but was higher in the reference population (13.8%).
Placenta previa was more common in women with CMT compared to the reference population (1.6% versus 0.4%). In addition, abnormal fetal presentation (8.4% versus 4.5%) was more common in the former, and all but 1 required a caesarean section. Premature births were more common in women with CMT compared to the reference populations (20.3% versus 6.9%), but most occurred between 34 and 36 weeks of gestation.
The mode of delivery in women with CMT did not differ from that of the control or reference populations. There were only 3 cases of postpartum bleeding in women with CMT disease (2.1%), but the study researchers observed no difference from the reference population. In addition, the incidence and type of complications in neonates of women with CMT did not differ from the controls and reference populations.
The results showed that during 18 of 193 pregnancies (9.3%), CMT disease status worsened in 14 of 86 patients (16.3%). In 14 of the 18 pregnancies, there was no recovery at all from worsening after delivery, with little recovery in 2 cases, good recovery in 1 patient, and full recovery in only 1 patient.
The study researchers collected data on 44 patients with the CMT1A subtype and 42 patients with other CMT types. The data showed that deterioration in CMT status was similar between patients with CMT1A and patients with other forms of CMT. All 3 cases of placenta previa occurred in patients with CMT1A. The difference to the non-CMT1A group, however, was not significant.
The study had several limitations, including its retrospective design and data based primarily on patient memory. In addition, the pregnancies reported by the patients occurred over a long period of time (1960-2015) and the data reported for the reference population were largely for the past few decades.
“We observed higher rates of placenta previa, abnormal presentations, and premature delivery in CMT, but pregnancy outcome and neonatal weight and health were similar to the reference populations,” concluded the study researchers.
Pisicotta C., Calabrese D., Santoro L. et al. Pregnancy in Charcot-Marie-Tooth disease: data from the national CMT registry. Neurology. Published online on December 15, 2020. doi: 10.1212 / WNL.0000000000010860