title: Favourable Outcome in Two Pregnancies in a Patient with 3-Hydroxy-3-Methylglutaryl-CoA Lyase Deficiency.
abstract: In patients with 3-hydroxy-3-methylglutaryl(HMG)-CoA lyase deficiency (OMIM 246450), five pregnancies have been described worldwide, which were either terminated or resulted in severe metabolic sequelae during pregnancy or delivery. Here, we report on a patient with HMG-CoA lyase deficiency, who underwent two uncomplicated pregnancies. The 19-year-old patient was admitted because of recurrent vomiting and nausea. Diagnostics revealed pregnancy at week 8 of gestation. Metabolic analyses revealed normal lactate and blood glucose levels and normal acid-base status. Urine organic acid analysis showed an elevated excretion of 3-CH3-glutaric acid, 2,3-CH3-glutaconic acid, and 3-CH3-3-OH-glutaric acid. Oral treatment with carnitine and glucose wes administered intravenously during the period of nausea and vomiting. After clinical recovery, a diet with 0.89 g/kg of protein/d and 38 kcal/kg body weight/d was given. Meals were taken every 3 h. Additionally, 70 g of starch was given at midnight to maintain normoglycemia at night time. Peripartum, a complete parenteral nutrition, was delivered through a central venous catheter. The patient delivered a healthy male infant by Caesarean section at week 38 of gestation (Apgar 9/10/10) and remained metabolically stable throughout the peripartum period. Postpartum nutrition was gradually changed from parenteral to oral diet. Two years later, the patient became pregnant again and presented with hyperemesis gravidarum. With metabolic monitoring and treatment as before no decompensation occurred. At week 38 of gestation, she delivered a healthy female infant by elective Caesarian section (Apgar 9/10/10). This case report describes the metabolic and obstetric management of two pregnancies in a patient with HMG-CoA lyase deficiency with favorable outcome without metabolic complications.
authors.affiliation: Department of Gastroenterology, Hepatology and Infectious Diseases, Heinrich-Heine University, Moorenstrasse 5, 40225, Düsseldorf, Germany. david.santosa@med.uni-duesseldorf.de.
authors.forename: David
authors.initials: D
authors.lastname: Santosa
authors.affiliation: Department of Gastroenterology, Hepatology and Infectious Diseases, Heinrich-Heine University, Moorenstrasse 5, 40225, Düsseldorf, Germany.|Gastroenterologie Brugg, Brugg, Switzerland.
authors.forename: Markus G
authors.initials: MG
authors.lastname: Donner
authors.affiliation: Department of Gastroenterology, Hepatology and Infectious Diseases, Heinrich-Heine University, Moorenstrasse 5, 40225, Düsseldorf, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Vom Dahl
authors.affiliation: Department of Gynecology, Heinrich-Heine University, Düsseldorf, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Fleisch
authors.affiliation: Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Heinrich-Heine University, Düsseldorf, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Hoehn
authors.affiliation: Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Heinrich-Heine University, Düsseldorf, Germany.
authors.forename: Ertan
authors.initials: E
authors.lastname: Mayatepek
authors.affiliation: Childrens Hospital, HELIOS Klinikum Krefeld, Krefeld, Germany.
authors.forename: Katrin
authors.initials: K
authors.lastname: Heldt
authors.affiliation: Childrens Hospital, HELIOS Klinikum Krefeld, Krefeld, Germany.
authors.forename: Tim
authors.initials: T
authors.lastname: Niehues
authors.affiliation: Department of Gastroenterology, Hepatology and Infectious Diseases, Heinrich-Heine University, Moorenstrasse 5, 40225, Düsseldorf, Germany.
authors.forename: Dieter
authors.initials: D
authors.lastname: Häussinger
keywords: 3-Hydroxy-3-methylglutaryl(HMG)-CoA lyase deficiency; Inherited metabolic disease; Pregnancy