AI Article Synopsis

  • FARAD is a rare condition affecting newborns of mothers with myasthenia gravis, caused by maternal antibodies targeting fetal AChRs, with only two documented cases from asymptomatic mothers.
  • A case study reports an asymptomatic mother with two FARAD children; the first child required significant medical intervention for severe symptoms, while the second child benefitted from preventive IVIG therapy during pregnancy and had a better outcome.
  • Findings suggest FARAD should be considered when diagnosing congenital neuromuscular disorders, and that prenatal IVIG treatment may improve health results for affected newborns.

Article Abstract

Background: Fetal acetylcholine receptor antibody-associated disorders (FARAD), caused by in utero exposure to maternal antibodies directed against the fetal acetylcholine receptor (AChR), is a rare condition occurring in newborns of myasthenic mothers. Only two cases of FARAD children born to asymptomatic mothers are published.

Case: We report a completely asymptomatic mother of two FARAD children presenting exclusively with positive AChR antibodies. After birth, the first child needed intensive care therapy due to generalized hypotonia, respiratory problems, dysphagia, necessitating tube feeding and gastrostomy. FARAD was suspected because of ptosis, a hypomimic face, and confirmed by increased AChR antibodies in the mother. The mother became pregnant again 2 years later. Since FARAD is likely to reoccur and it is known that intensity of maternal myasthenia gravis treatment determines postnatal outcome, monthly intravenous immunoglobulin (IVIG) therapy was started at 12 weeks gestational age. The second child needed a short mask ventilation for initial stabilization at birth, but her muscle weakness improved rapidly and tube feeding was not necessary. Similar to her sister a tent-shaped mouth and a somewhat myopathic face persisted, but motor milestones were reached in time.

Conclusions: These observations highlight that FARAD is an important differential diagnosis of genetically determined congenital neuromuscular disorders even in asymptomatic mothers, and that IVIG therapy during the pregnancy has the potential to improve the outcome of the children.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10601289PMC
http://dx.doi.org/10.1186/s42466-023-00280-6DOI Listing

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