Women with SMA can have successful pregnancies with team-based care
Case series shows multidisciplinary support can help manage pregnancy risks
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- Women with SMA can experience successful pregnancies and positive birth outcomes.
- Pregnancy in SMA involves risks uch as breathing challenges and preterm birth.
- Multidisciplinary team care, including respiratory support and planned delivery, is key to positive outcomes.
Women with spinal muscular atrophy (SMA) can experience successful pregnancies and give birth to healthy babies when supported by specialist, team-based care, according to a U.K. case series.
The report followed eight pregnancies in six women with SMA, all of which resulted in the birth of healthy babies — including the first documented successful pregnancy in a woman with SMA type 1, one of the most severe forms of the disease.
Coordinated care helped manage complex pregnancy risks
Although medical complications were common, affecting most pregnancies in the series, coordinated care from a multidisciplinary team helped tailor breathing support, carefully plan deliveries, organize neonatal care, and support mothers’ recovery, contributing to favorable outcomes for both mothers and babies.
“Our case series, of a rare neuromuscular condition in pregnancy, strongly supports that appropriate multi-professional and multi-speciality care for pregnant women living with SMA enhances the outcome for both mother and baby,” researchers wrote.
The study, “Pregnancy in women with spinal muscular atrophy (SMA): maternal and neonatal outcomes with multi-speciality management,” was published in the Journal of Neurology.
SMA is a rare genetic disorder marked by the progressive loss of motor neurons — the nerve cells that control muscle movement. This leads to muscle weakness and wasting that can affect a person’s ability to move and breathe.
Thanks to advances in nutritional care, respiratory support, and newer SMA treatments, life expectancy has improved, and more women with SMA are now reaching childbearing age.
Pregnancy, however, places additional strain on the respiratory system. Changes in breathing mechanics and lung function during pregnancy can raise the risk of complications for women with SMA.
Study tracks pregnancy outcomes in women with SMA
Here, researchers report on maternal and newborn outcomes from eight pregnancies in six women with SMA who received care at a specialized, multidisciplinary maternity center in London over an 18-year period (2007-2025).
The women had a median age of 29 at delivery. Four had SMA type 2, one had type 3, and one had type 1. All used wheelchairs before pregnancy, and three required noninvasive ventilation for breathing support. Six pregnancies occurred naturally, while two were conceived through in vitro fertilization.
Four women received pre-pregnancy counseling that included discussions about how SMA could affect their health during pregnancy. The researchers said this helped support shared decision-making and personalized care, allowing each woman to prepare for the challenges of pregnancy.
While pregnancy is likely to be more complicated than for healthy women, with appropriate counselling and clinical support, the overwhelming evidence is that both mother and baby will have good outcomes.
Because the muscles that support breathing may weaken further during pregnancy, the women underwent regular assessments of respiratory function throughout pregnancy. As pregnancy progressed, four of the six women experienced a decline in respiratory function during the second trimester. Three required increased noninvasive ventilation (NIV) support until delivery. All were able to return to their pre-pregnancy NIV settings within one month after giving birth.
All eight babies were delivered by planned cesarean section under general anesthesia following careful evaluation by the multidisciplinary team.
Regional anesthesia, often used in C-sections, was not suitable because all of the women had severe scoliosis — an abnormal curvature of the spine common in SMA — and five had previously undergone extensive spinal fusion surgery involving metal rods in the lower spine.
Six of the eight babies were born preterm, largely due to worsening maternal health during the third trimester. The median gestational age at birth was 35 weeks and five days.
Four newborns were admitted to neonatal intensive care, mainly for breathing-related complications linked to prematurity. There were also two neonatal readmissions.
Newborn outcomes were favorable overall
Despite these challenges, all babies survived, none had reported congenital abnormalities, and all were healthy at follow-up, the researchers noted.
After delivery, the women continued to receive close follow-up. Most returned to their pre-pregnancy health status within three months after giving birth. One woman experienced serious surgical complications after delivery, including a bowel injury and infection, which delayed recovery. She returned to her pre-pregnancy health status within one year.
“While pregnancy is likely to be more complicated than for healthy women, with appropriate counselling and clinical support, the overwhelming evidence is that both mother and baby will have good outcomes,” the researchers wrote. They added that “women living with SMA should not be discouraged from becoming pregnant.”
They emphasized, however, that these pregnancies require close monitoring and complex care that “should be led by a highly skilled multi-speciality team with experience of pregnancy in women with SMA.”
