842 - Intrathecal Baclofen Pump in Pregnancy: A Case Study

Case Diagnosis: Pregnancy in setting of intrathecal baclofen pump

Case Description: This is a case report of a 27-year-old female G2P1011 with a history of anoxic brain injury and spastic and dystonic quadriplegia that is managed with an ITBP placed in 2017. She became pregnant and successfully delivered a healthy, full-term infant via c-section. There were no baclofen-associated complications noted.

Discussions: Spasticity and dystonia are movement disorders that can result from various etiologies such as brain injury, spinal cord injury, adverse drug effect, neurological disease etc. Baclofen is an antispasmodic medication that can help manage/treat these disorders. It can be administered enterally or via an implanted intrathecal baclofen pump (ITBP). The use of an ITBP during pregnancy is sparse, with approximately 10 cases documented in the literature This case report supports the continued use of ITBP during the prenatal period of pregnancy for the management of severe spasticity/dystonia. Despite baclofen being classified as a pregnancy category C medication, our case study along with existing literature suggests that ITBP use during pregnancy is relatively safe, with a low risk of teratogenicity or infant baclofen withdrawal. However, it is noted that most deliveries in the literature were preterm, with only two cases resulting in full-term births; our case adds to these full-term outcomes.

Conclusions: This case report supports the continued use of an ITBP during pregnancy as it suggests minimal risk to both the patient and infant along with proper management of the patient’s spasticity.  Despite the complexities of our patient’s health and sociodynamic factors, she had a successful full-term delivery without complication. These findings highlight the need for larger studies to determine safe levels of ITBP use and to identify any potential adverse effects.