Medication Complications for Pregnant Women with Neuromuscular Disease

Article Highlights:
  • Some medications and  therapies prescribed in neuromusclar disease may pose risks to mother and baby during pregnancy and delivery.
by Amy Labbe on June 30, 2010 - 4:41pm

QUEST Vol. 17, No. 3

If you are pregnant or plan to become pregnant, discuss with your physician any medications you are taking. In all cases where medication is required, the risk to the fetus must be weighed against the health of the mother.

Information for the medications listed in this chart was excerpted from each drug’s prescribing information. To view prescribing information for these or any other medications, visit the drug or company website. If you're unable to find an official website for the medication or manufacturer, do an Internet search by entering the name of the medication and the phrase "prescribing information."

Medication or
Prescribed for Potential Problems
During Pregnancy

alglucosidase alfa


acid maltase deficiency (Pompe disease)

  • No studies have been conducted with this drug in pregnant women.

  • In short-term studies in a mouse model, this drug did not impair fertility or harm a growing fetus.

  • No long-term studies in animals have been performed.


(Azasan, Imuran)


inclusion-body myositis


myasthenia gravis

  • Can affect fertility in both men and women.

  • Animal studies have revealed evidence that use of azathioprine can cause malformations in a fetus.

  • Has been shown to cross the placenta and cause harm to the fetus, with some data showing an increased risk of intrauterine growth retardation, premature birth and low birth weights.

  • Anecdotal evidence exists from cases in which the drug was used during pregnancy by women with conditions such as kidney transplant or systemic lupus. Congenital anomalies were observed in children born to these women, including: missing or extra fingers or toes; congenital heart disease; umbilical hernia; deformities in the legs, feet, penis and skull. Some babies had problems producing bone marrow.


(Kemstro, Lioresal)

amyotrophic lateral sclerosis

  • No adequate and well-controlled studies in pregnant women have been conducted.

  • Female rats treated with baclofen experienced an increase in incidence of ovarian cysts.

  • Animal studies in rats have revealed an increased incidence of birth defects.

  • Abnormalities in the bones of forelimbs and hindlimbs were observed in fetuses of rabbits treated with the drug.



amyotrophic lateral sclerosis

  • Limited experience with the use of clonazepam during pregnancy has been reported, but an increased risk of birth defects has been associated with use of all known anticonvulsant agents, such as clonazepam

  • Breating and feeding problems in newborns have been observed.


prednisone tablets (Deltasone)

intravenous methylprednisolone

sodium succinate (Solu-Medrol)

congenital MD

distal MD

Duchenne MD

Emery-Dreifuss MD

facioscapulohumeral MD

limb-girdle MD

myotonic MD

oculopharyngeal MD

myasthenia gravis

  • Studies in animals have shown that corticosteroids cause birth defects)

  • Studies on correlation of birth defects with corticosteroids have not been done in humans

  • Anecdotal evidence reported by medical professionals suggests a lack of abnormalities in children whose mothers were treated with typical doses of prednisone and methylprednisolone throughout pregnancy

  • Clinical experience has revealed that corticosteroid use in pregnant women may correlate with premature rupture of amniotic membranes and low birth weights in infants.


(Cytoxan, Neosar, Lyophilized)


inclusion-body myositis


  • May affect egg production in women and sperm production in men. Use of cyclophosphamide by the father prior to conception has been associated with birth defects.

  • Normal pregnancies and fetal development have been observed in women who used this drug during pregnancy, but it also has resulted in severe and multiple birth defects in some instances.


(Gengraf, Neoral, Sandimmune)


inclusion-body myositis


  • Human data have revealed evidence of premature birth and low birth weight in babies born to women who took this drug during pregnancy, but the drug does not appear to cause birth defects.

  • In data gleaned from 15 studies, analysis showed that the overall prevalence of major birth defects in babies born to women taking this drug did not vary substantially from that reported in the general population.



used preoperatively to prevent or halt the development of malignant hypertermia

  • The safety of this drug in women during or prior to pregnancy has not been established.




inclusion-body myositis


  • Data from human pregnancy studies are not available.

  • Developmental toxicity studies performed in rats and rabbits at doses ranging from 60 to 100-fold higher than the human dose have revealed no evidence of harm to the fetus.


(Gabarone, Neurontin)

amyotrophic lateral sclerosis

  • It is not known whether Neurontin is harmful to an unborn baby, but some observations have indicated that gabapentin does cross the placenta and accumulate in the fetus.

  • In animal studies, the drug proved toxic to the fetus, causing delayed formation of several bones and accumulation of urine in the kidneys.

hydroxychloroquine sulfate

(Plaquenil, Quineprox)


inclusion-body myositis


  • There are no controlled data in human pregnancy. However, the findings of one study have shown preliminary safety support for the use of this drug during pregnancy.

  • Animal studies have revealed that the drug passes rapidly across the placenta, accumulates selectively in the eyes of the fetus and still is present in those tissues five months after elimination from the rest of the body.

infusion of mixed

(Gammar, Gammagard, Sandoglobulin, others)


inclusion-body myositis


myasthenia gravis

  • IVIg has been shown to cross the placenta after 32 weeks gestation, but successful outcomes in human pregnancy have been observed.

  • Noted risks for the use of IVIg in pregnancy are blockage of a blood vessel by a blood clot, and kidney inflammation.

  • Animal studies have not been reported.


amyotrophic lateral sclerosis

  • Studies in pregnant women who were treated with magnesium sulfate by injection showed no risk of increased fetal abnormalities.

  • Magnesium sulfate often is used to treat severe high blood pressure during pregnancy.

  • It should not be prescribed to pregnant women with myasthenia gravis, as it is known to exacerbate the disease.

  • Although the drug has a depressant effect on the central nervous system, evidence has shown it does not adversely affect the mother, fetus or newborn when used to treat high blood pressure and fluid retention (pre-eclampsia) or the convulsions or coma that may follow (eclampsia).


(Rheumatrex, Folex, Mexate)


inclusion-body myositis


  • May cause birth defects and fetal and newborn death if taken during pregnancy.

  • Pregnancy should be avoided if either partner is receiving this drug. Men should wait three months after therapy, and women should wait at least one ovulatory cycle before trying to conceive a child.

mycophenolate mofetil



inclusion-body myositis


myasthenia gravis

  • There are no controlled data in human pregnancy, but the drug has been associated with increased risk of first trimester pregnancy loss and increased risk of birth defects.

  • National Transplantation Pregnancy Registry (NTPR) data on mycophenolate mofetil-exposed pregnancies in transplant patients showed that 45 percent of pregnancies ended in spontaneous abortions. Of live-born babies, 22 percent had birth defects.



  • There are no controlled data in human pregnancy.

  • Animal studies have not shown this drug to cause birth defects, but there has been evidence both in animals and humans of spontaneous abortion.

  • It's advised that this drug not be used in the third trimester, as it may affect the fetus' cardiovascular system, and also prolong labor and delivery.


(Prostigmin, Bromide)

myasthenia gravis

  • There are no adequate studies of the use of this drug in pregnant women.


Note: plasmapheresis is a procedure, not a medication.


inclusion-body myositis


myasthenia gravis

Lambert-Eaton syndrome

  • May alter blood volume in the mother and cause low blood pressure, which can endanger both mother and fetus.



amyotrophic lateral sclerosis

  • There are no controlled data on the use of this drug in human pregnancy.

  • There is evidence that men being treated with this drug have an increased risk of contributing to birth defects in offspring.

  • Animal studies have shown that pregbalin crosses the placenta and has resulted in increased incidences of malformations, slowed growth, nervous and reproduction system impairment, decreased fetal body weights and fetal death.

pyridostigmine bromide


myasthenia gravis

  • No information on the safety of this drug during pregnancy in humans has been established.

  • Drugs that are biochemically similar to pyridostigmine bromide have not been reported to cause birth defects; however, temporary muscle weakness has occurred in some newborns whose mothers took such drugs during pregnancy.



amyotrophic lateral sclerosis

  • There are no controlled data on use of this drug in human pregnancy.

  • Animal studies have revealed evidence that the drug causes fetal malformations.

  • It's known that quinine crosses the placenta and accumulates in fetal blood.

  • In a study of women with a form of malaria, birth defects were observed in 21 infants exposed to high doses of quinine during the first trimester.



amyotrophic lateral sclerosis

  • There are no adequate and well-controlled studies in pregnant women.

  • At higher-than-normal doses, riluzole impaired fertility when administered to male and female rats.

  • In studies in rats given the drug prior to and during mating and pregnancy, riluzole caused decreased implantations, increased intrauterine death and viability and growth of offspring.

  • Administration of higher-than-normal doses of the drug to pregnant rats and rabbits proved toxic to both fetus and mother.



Note: This muscle relaxant is a "depolarizing" relaxant often used with anesthesia.

May be of particular concern in:

amyotrophic lateral sclerosis

central core disease

myasthenia gravis

myotonia congenita

Myotonic muscular dystrophy and some other MDs

periodic paralysis

spinal muscular atrophy

  • Can trigger a malignant hyperthermia reaction in people with central core disease, myasthenia gravis and some muscular dystrophies.
    (Malignant hyperthermia is a potentially fatal abnormal response to inhaled anesthetics and certain muscle relaxants. It causes uncontrolled muscle contractions, accelerated metabolism, high fever, and, if not treated, death.)

  • Can affect heart rhythm in people with spinal muscular atrophy or ALS.

  • Can cause prolonged weakness after surgery in those with periodic paralysis.

  • Can make muscles rigid, complicating some medical procedures, in people with myotonic muscular dystrophy or myotonia congenita.

  • It is not known whether succinylcholine adversely affects reproductive capacity, or if it causes fetal harm when administered to a pregnant woman. No information on the safety of this drug during pregnancy in humans has been established.

  • Animal reproduction studies have not been conducted with succinylcholine chloride.

  • A higher number of women who are pregnant, versus those who are not, may have increased sensitivity to the drug (prolonged duration of slowing of breathing).

  • Small amounts of the drug are known to cross the placenta. Depending on the dose given the mother during delivery, a newborn may experience slowed breathing and lack of muscle tone.




inclusion-body myositis


  • In a study of 100 pregnancies in 84 mothers, there were 68 live births in which the most common complications to the newborns were temporary low oxygen levels, raised potassium levels in the blood and kidney problems.

  • Some animal studies have revealed an increased incidence of abortion, resorption of the fetus, and malformations. The drug also was found to be toxic to the mother.

  • It's known that Tacrolimus crosses the placenta.

  • The drug has been used successfully during pregnancy in a limited number of cases; however, raised serum potassium levels and kidney problems in newborns have been reported.



amyotrophic lateral sclerosis

  • There are no controlled data on use of this drug in human pregnancy.

  • Animal studies have shown evidence of increased length of gestation, increased loss of pups, and impaired development.


(Co-Q10, Coenzyme Q10, Idebenone, LiQsorb, Liquid Co-Q10, NutraDrops, QuinZyme, others)

Friedreich's ataxia

  • Information regarding the safety of ubiquinone in pregnancy is lacking, but its use is not recommended.

  • Animal studies have revealed no harmful effects.
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