Mitochondrial disorders-challenges in pregnancy: a case report

Authors

  • Malini Sukayogula Department of Obstetric Medicine, Fernandez Hospital, Hyderabad, Telangana, India
  • Tarakeswari Surapaneni Department of Obstetric Medicine, Fernandez Hospital, Hyderabad, Telangana, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20243964

Keywords:

Mitochondrial, Myopathy, Pregnancy, Mitochondrial disorders, Mitochondrial DNA depletion syndromes

Abstract

Mitochondrial disorders (MD) encompass a diverse group of genetic disorders affecting the intra-cellular energy-producing organelles. During pregnancy, these disorders present unique challenges that warrant special attention. Here, we report a case of a 28-year-old woman who presented with ptosis since, 11 years of age. Muscle biopsy revealed mitochondrial cytopathy, but genetic evaluation was not done. She presented to us in early pregnancy. Whole Mitochondrial genome sequencing showed no pathological / likely pathological variant. Whole Exome sequencing revealed a Homozygous missense variant in exon 6 of RRM2B gene (c.629 A>G;p.lys 210 Arg) associated with Mitochondrial DNA depletion syndrome 8A and 8B, which has an autosomal recessive pattern of inheritance. The review of literature discusses the implications of MD on pregnancy outcomes and explores the management strategies to optimize maternal and fetal outcomes.

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References

Spinazzola A, Invernizzi F, Carrara F, Lamantea E, Donati A, Dirocco M, et al. Clinical and molecular features of mitochondrial DNA depletion syndromes. J Inherit Metab Dis. 2009;32(2):143–58.

El-Hattab AW, Scaglia F. Mitochondrial DNA depletion syndromes: review and updates of genetic basis, manifestations, and therapeutic options. Neurotherapeutics. 2013;10(2):186-98.

Arpa J, Cruz-Martínez A, Campos Y, Gutiérrez-Molina M, García-Rio F, Pérez-Conde C, et al. Prevalence and progression of mitochondrial diseases: A study of 50 patients: Study of Mitochondrial Diseases. Muscle Nerve. 2003;28(6):690–5.

Skladal D, Halliday J, Thorburn DR. Minimum birth prevalence of mitochondrial respiratory chain disorders in children. Brain J Neurol. 2003;126(8):1905–12.

Gorman GS, Schaefer AM, Ng Y, Gomez N, Blakely EL, Alston CL, et al. Prevalence of nuclear and mitochondrial DNA mutations related to adult mitochondrial disease. Ann Neurol. 2015;77(5):753–9.

Barca E, Long Y, Cooley V, Schoenaker R, Emmanuele V, DiMauro S, et al. Mitochondrial diseases in North America. Neurol Genet. 2020;6(2):402.

Say RE, Whittaker RG, Turnbull HE, McFarland R, Taylor RW, Turnbull DM. Mitochondrial disease in pregnancy: a systematic review. Obstet Med. 2011;4(3):90–4.

Taylor RW, Turnbull DM. Mitochondrial DNA mutations in human disease. Nat Rev Genet. 2005;6(5):389–402.

Pfeffer G, Blakely EL, Alston CL, Hassani A, Boggild M, Horvath R, et al. Adult-onset spinocerebellar ataxia syndromes due to MTATP6 mutations. J Neurol, Neurosurg Psych. 2012;83(9):883-6.

Karaa A, Elsharkawi I, Clapp MA, Balcells C. Effects of mitochondrial disease/dysfunction on pregnancy: A retrospective study. Mitochondrion. 2019;46:214–20.

Feeney C, Lim A, Fagan E, Blain A, Bright A, Maddison J, et al. A case-comparison study of pregnant women with mitochondrial disease – what to expect? BJOG Int J Obstet Gynaecol. 2019;126(11):1380–9.

De Laat P, Fleuren LHJ, Bekker MN, Smeitink JAM, Janssen MCH. Obstetric complications in carriers of the m.3243A>G mutation, a retrospective cohort study on maternal and fetal outcome. Mitochondrion. 2015;25:98–103.

De Vries MC, Brown DA, Allen ME, Bindoff L, Gorman GS, Karaa A, et al. Safety of drug use in patients with a primary mitochondrial disease: An international Delphi-based consensus. J Inherit Metab Dis. 2020;43(4):800–18.

Goldstein A, Falk MJ. Single Large-Scale Mitochondrial DNA Deletion Syndromes. In: Adam MP, Feldman J, Mirzaa GM, Pagon RA, Wallace SE, Bean LJ, et al editors. GeneReviews®. Seattle (WA): University of Washington. 1993. Available at: http://www.ncbi.nlm.nih.gov. Accessed on 21 August 2024.

Overview. Diabetes in pregnancy: management from preconception to the postnatal period. Guidance. NICE. 2015. Available at: www.nice.org.uk/guidance. Accessed on 23 August 2024.

Moriarty KT, Mcfarland R, Whittaker R, Burch J, Turnbull HE, Taylor RW, et al. Pre-eclampsia and magnesium toxicity with therapeutic plasma level in a woman with m.3243A>G melas mutation. J Obstet Gynaecol. 2008;28(3):349.

Nakamura E, Ushijima J, Samejima K, Akashi K, Hotta D, Kadowaki K, et al. Pregnancy with mitochondrial disease complicated by threatened preterm labor and preeclampsia. Hypertens Res Pregnancy. 2016;4(1):38–41.

Newcastle mitochondrial disease guidelines anaesthesia & peri-operative care in adult patients: Screening and Subsequent Management. Available at: www.mitochondrialncg.nhs.uk. Accessed on 22 August 2024.

Newcastle mitochondrial disease guidelines cardiac involvement in adult mitochondrial disease: screening and initial management. Available at: www.mitochondrialncg.nhs.uk. Accessed on 25 August 2024.

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Published

2024-12-27

How to Cite

Sukayogula, M., & Surapaneni, T. (2024). Mitochondrial disorders-challenges in pregnancy: a case report. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 14(1), 258–261. https://doi.org/10.18203/2320-1770.ijrcog20243964

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Section

Case Reports