Objective:

NA

Background:

Baclofen is a muscle relaxant commonly used in the setting of spasticity due to its ability to activate gamma-aminobutyric acid B receptors. Due to frequent therapeutic use, the adverse effects of baclofen have been well delineated. However, in the case of interactions during pregnancy, little information exists in the setting of maternal intrathecal baclofen (ITB) use and neonatal outcomes.  

Design/Methods:

NA

Results:

We report a case of a 36-year-old woman with a history of spastic quadriplegic cerebral palsy and use of ITB pump during pregnancy. The baclofen pump was initially placed in the left lower abdomen at T2, 15 years prior to gestation. The patient was reported to be receiving 400 mcg/day of baclofen at the start of her pregnancy and continued at this dose throughout the remainder of her pregnancy. Given this history and medication use, the pregnancy was established as high risk and followed by close obstetric monitoring with planned cesarean section at 39 weeks. With the exception of maternal anemia and low-lying placenta, pregnancy and fetal growth progressed normally. The patient presented at 36 weeks and 6 days with complete breech effacement and spontaneous vaginal delivery quickly followed. The infant’s APGAR scores were 6 and 9 at 1 and 5 minutes respectively, with a birth weight of 2594 grams (20th percentile for this gestational age). Physical examination following delivery revealed a morphologically normal female without significant findings, including negative echocardiogram. The infant had a failed newborn hearing screening documented after birth but was otherwise discharged with family 2 days after delivery. 

Conclusions:

Our ability to apply evidence-based medicine in these situations relies on the handful of case reports that are currently published. It is important that we continue to explore ITB safety during this sensitive time, as its use for providing symptomatic relief of spasticity in mothers is invaluable.