The management of myasthenia gravis in pregnancy

As with several autoimmune diseases, myasthenia gravis (MG) occurs frequently in young women in their childbearing years. The treatment of MG in women therefore poses unique and challenging issues to neurologists, obstetricians, and neonatologists as the safety of both mother and fetus needs to be carefully considered when choosing a therapeutic plan. The severity of generalized weakness and the potential for respiratory insufficiency and myasthenic crises in the mother should dictate how aggressive a treatment plan should be. The potential effects of immunosuppressant medications on the fetus should always be weighed against the risk of myasthenic crises and its potential to endanger both mother and fetus. Successful management of MG during pregnancy and in the postpartum period is possible in many cases but requires collaboration between the obstetrician, the neurologist, and a well-informed patient. The neurologist should be able to counsel women and discuss treatment options and pregnancy risks based on the best current knowledge, so that women will be able to make an informed decision and successfully complete pregnancy.