1118 - Maternal Midodrine Administration During Pregnancy in a Patient with Complete T8 AIS A Spinal Cord Injury and Neonatal Follow-Up: A Case Report

A 32-year-old G2P0111 at 24 weeks with chronic T8 AIS A spinal cord injury, ITB pump, mechanical mitral valve, history of DVT/PE, and chronic wounds presented with hypotension, syncope, and lightheadedness unresponsive to fluids. Workup during admission for an infected sacral wound revealed multifactorial hypotension due to impaired sympathetic tone, pregnancy-related vasodilation, and infection. Cardiogenic, hypovolemic, and obstructive causes were excluded. Despite hypotension, heart rate remained low, consistent with autonomic dysregulation. After multidisciplinary consultation, midodrine 5 mg TID was started with symptom improvement and stable fetal status. At 36 weeks, cesarean delivery was performed for non-reassuring fetal heart tones. Male infant was SGA (4th percentile), required brief CPAP for TTN, and was admitted to NICU. Additional findings included feeding difficulties, mild laryngomalacia, ventral hypospadias, and NRXN1 gene deletion. Infant discharged on day 18.

Discussions:

Neurogenic hypotension is common in pregnant patients with high spinal cord injury; however, there is limited research on fetal effects of maternal midodrine use due to its incomplete safety profile in pregnancy. Extensive workup for hypotension and syncope was unrevealing but suggested a multifactorial etiology related to chronic comorbidities exacerbated by pregnancy. This case is notable for its comprehensive multidisciplinary management and favorable maternal-fetal outcomes despite polypharmacy, infection, and chronic wounds. It also highlights the potential role of midodrine in pregnancy and short-term fetal well-being. While follow-up data were limited to the neonatal period, no immediate adverse effects attributable to midodrine were observed.

Conclusions:

This case supports cautious midodrine use for neurogenic hypotension during pregnancy in carefully selected SCI patients. These findings suggest that midodrine may be tolerated in select pregnant patients, though longer-term safety data remain lacking. A multidisciplinary, individualized approach allowed safe symptom control and successful delivery, highlighting the need for tailored care strategies in medically complex pregnancies.