STUDY ON THE TWO-DIRECTIONAL RELATIONSHIP BETWEEN MYASTHENIA GRAVIS AND PREGNANCY
Abstract
Due to the high prevalence of myasthenia gravis (MG) in women of reproductive age, pregnancy in patients with MG is not uncommon. This requires special clinical and therapeutic caution. There is a two-way relationship between MG and pregnancy: Pregnancy can affect the course of the disease, but MG can affect childbirth and the occurrence of postnatal complications. The purpose of our study was to evaluate the clinical course, delivery, and neonatal outcome of pregnant women with the diagnosis of myasthenia gravis. The clinical course of the disease during pregnancy, labor, and postpartum period was reviewed, as well as the neonatal period in the 23 infants born to 15 MG mothers. Spontaneous abortion was observed in two pregnant women (8%) in the second month of pregnancy. One newborn was diagnosed with transitory neonatal MG. There were no stillbirths or physical anomalies. Clinical worsening was recorded during 10 pregnancies (40%), in 8 pregnant women. The clinical course of MG in pregnancy is variable and unpredictable, but pregnancy does not affect the long-term course of MG. Spontaneous abortion is a potential complication in pregnant women with MG. Cesarean section is a more frequent intervention in pregnant women with MG compared to the general population of women. Thymectomy in mothers with MG before pregnancy could potentially have a positive benefit for the newborn. Neonatal transient myasthenia was uncommon in our patient population. No congenital abnormalities were discovered in the 23 babies delivered at our institution.
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Batocchi AP, Majolini L, Evoli A, Lino MM, Minisci C, Tonali P. Course and treatment of myasthenia gravis during pregnancy. Neurology 1999;52:447-52. [CrossRef] [PubMed]
Batocchi AP. Pregnancy and myasthenia gravis. In: Vincent A, Martino G. Autoantibodies in neurological diseases. Milan: Springer-Verlag Italia, 2002;28-39. [CrossRef]
Carr A, Cardwell C, McCarron P, McConville J. A systematic review of population based epidemiological studies in Myasthenia Gravis. BMC Neurology 2010; 10:46. [CrossRef] [PubMed]
Djelmis J, Sostarko M, Mayer D, Ivanisevic M. Mya-sthenia gravis in pregnancy: report on 69 cases. Eur J Obstet Gynecol Reprod Biol 2002;104:21-5. [CrossRef] [PubMed]
Ducci RD, Lorenzoni PJ, Kay CSK, Werneck LC, Scola RH. Clinical follow-up of pregnancy in myasthenia gravis patients. Neuromusc Disord 2017;27:352-7. [CrossRef] [PubMed]
Eden RD, Gall SA. Myasthenia gravis and pregnancy: a reappraisal of thymectomy. Obstet Gynecol 1983; 62(3):328-33. [CrossRef] [PubMed]
Eymard B, Morel E, Dulac O, Moutard-Codou ML, Jeannot E, Harpey JP, et al. Myasthenia and preg-nancy: a clinical and immunologic study of 42 cases (21 neonatal myasthenia cases. Rev Neurol (Paris) 1989;145:696-701. [PubMed]
Gilhus NE HY. Maternal myasthenia gravis represents a risk for the child through autoantibody transfer, immunosuppressive therapy and genetic influence. Eur J Neurol 2018;2018:1-8. [CrossRef] [PubMed]
Gilhus NE. Myasthenia Gravis Can Have Consequences for Pregnancy and the Developing Child. Front Neurol 2020. [CrossRef] [PubMed]
Hoff JM, Daltveit AK, Gilhus NE. Myasthenia gravis: consequences for pregnancy, delivery, and the new-born. Neurology 2003;61:1362-6. [CrossRef] [PubMed]
Macfarlane AJ, Blondel B, Mohangoo AD, Cuttini M, Nijhuis J, Novak Z, et al. Wide differences in mode of delivery within Europe: risk-stratified analyses of aggregated routine data from the Euro-Peristat study. BJOG 2016;123(4):559-68. [CrossRef] [PubMed]
Midelfart-Hoff J, Kjersti-Daltveit A, Gilhus NE. Mya-sthenia gravis-Conseqences for pregnancy, delivery, and the newborn. Neurology 2003;61:1362-6. [CrossRef] [PubMed]
Newsom-Davis J. The emerging diversity of neuro-muscular junction disorders. Acta Myol 2007; 26(1): 5-10. [PubMed]
Norwood F, Dhanjal M, James N, Jungbluth H, Kyle P, et al. Myasthenia in pregnancy: best practice guide-lines from a UK multispecialty working group. J Neurol Neurosurg Psychiatry 2013;00:1-6. [CrossRef] [PubMed]
Plauche WC. Myasthenia gravis. Clin Obset Gynecol 1983;26:592-604. [CrossRef] [PubMed]
Ramirez C, de Seze J, Delrieu O, Stojkovic T, Delalande S, Fourrier F, et al. Myasthenia gravis and pregnancy: clinical course and management of deli-very and the postpartum phase. Revue Neurologique 2006;162:330-8. [CrossRef]
Rosenbaum RB, Donaldson J. Peripheral nerve and neuromuscular disorders. Neurol Clin 1994;12:471-3. [CrossRef] [PubMed]
Roth TC, Raths J, Carboni G, Rösler K, Schmid RA. Effect of pregnancy and birth on the course of mya-sthenia gravis before or after transsternal radical thymectomy. Journal of Cardio-thoracic Surgery 2006; 29:231-5. [CrossRef] [PubMed]
Tanacan A, Fadiloglu E, Ozten G, Gunes AC, Orgul G, Beksac MS. Myasthenia gravis and pregnancy: retro-spective evaluation of 27 pregnancies in a tertiary center and comparison with previous studies. Irish J Med Sci 2019;188:1261-7. [CrossRef] [PubMed]