Guillain-Barré Syndrome Complicating First Trimester Pregnancy: A Case Report and Review of Literature

Abstract

Background: Guillain-Barre syndrome (GBS) is a rare immune mediated polyradiculoneuropathy, causing muscle weakness, hyporeflexia and dysesthesia. There is no specific guideline for management of GBS during pregnancy in general and first term in particular. Objectives:We report a 26-year-old nullipara who developed GBS in early pregnancy and present an overview of recommended treatment, maternal and fetal outcomes and pathogens associated with GBS in women diagnosed in first trimester pregnancy. Methods:We performed a systematic literature search using Embase and Web of Science databases. Eligible publications included all English reports of the last twenty years describing GBS diagnosed in the first trimester of pregnancy. Results:The literature search showed 89 unique articles of which four fulfilled our inclusion criteria. Intravenous immunoglobulins (IVIG) were the treatment of choice administered to the pregnant women diagnosed with GBS. All women recovered completely. Two articles report Cytomegalovirus (CMV) infection, leading to congenital infection in one case and in utero fetal death in another. One woman delivered a healthy baby after receiving mechanical ventilation for 18 weeks and one woman had a miscarriage. We present a case diagnosed with GBS without known causative agent, who recovered after IVIG treatment and delivered a healthy neonate at term. Conclusion:The treatment of GBS in pregnant patients is similar to the treatment of other patients and consists of IVIG and/or plasmapheresis and supportive care. The severity of polyradiculopathy seems to be unrelated to fetal outcomes, in contrast to the causative infection. CMV infection should be evaluated as causative agent.