Pregnancy in Patients With Hansen Disease

Abstract

Three pregnancies occurred in a cohort of 40 patients with Hansen disease during a 6-year period. There are few recent reports in the English literature that deal with pregnancy in patients with Hansen disease. These 3 cases are presented in the context of previously reported cohorts. In patient 1, symptoms of the disease appeared during pregnancy. In patient 2, reactivation vs reaction occurred during pregnancy in a previously treated patient. In patient 3, the fetus was exposed to 3 antimicrobial drugs during the first trimester. The pregnant state causes a relative decrease in cellular immunity. This decrease allows Mycobacterium leprae to proliferate, which may precipitate or worsen disease, leading to permanent nerve damage. Careful management of reactional states and treatment of patients with dapsone monotherapy can prevent this nerve damage. Infants are usually much less affected than mothers; however, selection of the mother's antimicrobial regimen must ensure adequate control of the bacteria while avoiding teratogenicity and in utero adverse effects.