Fetal exposure to 3,4-diaminopyridine in a pregnant woman with congenital myasthenia syndrome.
OBJECTIVE
To report a case of fetal exposure to pyridostigmine and 3,4-diaminopyridine (3,4-DAP) in a pregnant woman with congenital myasthenia syndrome (CMS).


METHODS
A 31-year-old woman with postsynaptic CMS, not genetically characterized, was being treated with pyridostigmine and 3,4-DAP. She decided to become pregnant, despite having been informed about the paucity of available information on the possible risks of these drugs for the fetus. The dose of pyridostigmine remained stable throughout the pregnancy (60 mg every 8 h), and the 3,4-DAP dose was adjusted according to the patient's level of fatigue (20 mg/day, with occasional additional doses of 5 mg). At 25 weeks' gestation, ultrasonography confirmed the presence of only one umbilical artery. The results of other tests were normal. At 38 weeks' gestation, a healthy male neonate was born. His APGAR scores were 9 and 10 at 1 and 5 minutes, respectively. Five months later, the infant was healthy and his pediatric progress had been uneventful.


CONCLUSIONS
It was difficult to find information about the possible congenital defects related to the use of 3,4-DAP because it is a rarely used drug. This case attracted our interest because it is an uncommon disease, and we found no reports on the use of 3,4-DAP during pregnancy. To our knowledge, as of this writing, this is the first published report of the use of 3,4-DAP during pregnancy.


CONCLUSIONS
A successful pregnancy with a healthy infant was achieved after fetal exposure to 3,4-DAP and pyridostigmine.
Department of Pharmacy, La Fe University Hospital, Valencia, Spain. pelufo_ana@gva.es
Ana
A
Pelufo-Pellicer
Emilio
E
Monte-Boquet
Eva
E
Romá-Sánchez
Carlos
C
Casanova-Sorní
Jose L
JL
Poveda-Andrés
D015761:4-Aminopyridine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000328:Adult; D000077770:Amifampridine; D001034:Apgar Score; D004359:Drug Therapy, Combination; D005260:Female; D047109:Fetal Development / Q000187:drug effects*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D020294:Myasthenic Syndromes, Congenital / Q000188:drug therapy*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy*; D011256:Pregnancy Outcome; D011729:Pyridostigmine Bromide / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use
D015761:4-Aminopyridine; D011729:Pyridostigmine Bromide; D000077770:Amifampridine