Clinical features and maternal and fetal outcomes in women with Guillain-Barré syndrome in pregnancy

• Published in: Journal of neurology Vol. 270; no. 9; pp. 4498 - 4506
• Main Authors: Krief, Nolwenn, Gabriel, René, Cauquil, Cécile, Adams, David, Fargeot, Guillaume, Maisonobe, Thierry, Osman, David, Schmidt, Matthieu, Chanson, Jean-Baptiste, Bigaut, Kevin, Sole, Guilhem, Tard, Céline, Nicolas, Guillaume, Pereon, Yann, Aure, Karine, Lagrange, Emmeline, Lefilliatre, Mathilde, Labeyrie, Marc-Antoine, Echaniz-Laguna, Andoni
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-09-2023; Springer Nature B.V; Springer Verlag
• Subjects: Adult; Age; Cesarean Section; Cytomegalovirus; Cytomegalovirus Infections; Demyelination; Female; Fetus; Fetuses; Guillain-Barre syndrome; Guillain-Barre Syndrome - complications; Guillain-Barre Syndrome - diagnosis; Guillain-Barre Syndrome - therapy; Humans; Immunoglobulins; Infections; Inflammation; Life Sciences; Medicine; Medicine & Public Health; Neurology; Neurons and Cognition; Neuroradiology; Neurosciences; Original Communication; Patients; Pregnancy; Retrospective Studies; Pregnancy; Cytomegalovirus; Guillain-Barré syndrome; Cytomegalovirus; Guillain-Barré syndrome; Pregnancy
• ISSN: 0340-5354; 1432-1459
• DOI: 10.1007/s00415-023-11808-w

Background
Guillain–Barre syndrome (GBS) is an acute inflammatory polyradiculoneuropathy rarely observed during pregnancy.
Methods
In this retrospective study, we analyzed the characteristics of pregnant women with GBS (pGBS) diagnosed in French University Hospitals in the 2002–2022 period and compared them with a reference group of same-age non-pregnant women with GBS (npGBS) identified in the same institutions & timeframe.
Results
We identified 16 pGBS cases. Median age was 31 years (28–36), and GBS developed in the 1st, 2nd, and 3rd trimester in 31%, 31% and 38% of cases respectively. A previous infection was identified in six cases (37%), GBS was demyelinating in nine cases (56%), and four patients (25%) needed respiratory assistance. Fifteen patients (94%) were treated with intravenous immunoglobulins, and neurological recovery was complete in all cases (100%). Unscheduled caesarean section was needed in five cases (31%), and two fetuses (12.5%) died because of cytomegalovirus (CMV) infection (1 case) and HELLP (Hemolysis, Elevated Liver enzymes and Low Platelets) syndrome (1 case). In comparison with a reference group of 18 npGBS women with a median age of 30 years (27–33), pGBS patients more frequently had CMV infection (31% vs 11%), had a prolonged delay between GBS onset and hospital admission (delay > 7 days: 57% vs 12%), more often needed ICU admission (56% vs 33%) and respiratory assistance (25% vs 11%), and more often presented with treatment-related fluctuations (37% vs 0%).
Conclusions
This study shows GBS during pregnancy is a severe maternal condition with significant fetal mortality.