The management of pregnancy in maple syrup urine disease: experience with two patients

Abstract

We describe the management and outcomes of pregnancy in two women affected with Maple syrup urine disease (MSUD). Both patients had classical disease diagnosed in the newborn period and were managed with low-protein diets and supplements, although compliance was moderately poor throughout life. Both pregnancies were complicated by poor compliance and one patient had a metabolic decompensation, which included seizures and profound encephalopathy, at the end of the first trimester. Peri-partum management required a coordinated team approach including a high-calorie and low-protein diet. Both patients had elevated leucine levels in the post-partum period - one due to mastitis and the other due to poor dietary and supplement compliance combined with uterine involution. On later review, leucine had returned to pre-pregnancy levels. Both infants were unaffected and have made normal developmental progress in the subsequent 1 to 2 years.

Fig. 1

Leucine levels (■ – μmol/L, left axis) and natural protein intake (x – g, right axis) plotted against gestational age. The peak at week 15 corresponds to her leucine level upon return from overseas

Fig. 2

Leucine levels (■ – μmol/L, left axis) and natural protein intake (x – g, right axis) plotted against days post partum. An episode of mastitis was diagnosed on day 12

Fig. 3

Leucine levels (■ – μmol/L, left axis) and natural protein intake (x – g, right axis) plotted against gestational age

Fig. 4

Leucine levels (■ – μmol/L, left axis) and natural protein intake (x – g, right axis) plotted against days post partum