Pregnancy complicated by Myasthenia gravis - twelve years experience

The aim of the study was to evaluate the effect of Myasthenia gravis (MG) on the course of pregnancy, labor and delivery, and the condition of neonate.

Retrospective chart review of pregnant patients with MG hospitalized in tertiary care center over 12 year period was performed. Course of MG before and during pregnancy, mode of delivery, and condition of the newborn were analyzed.

There was 42 913 deliveries in the Polish Mother's Research Institute in Lodz during analyzed period. Thirteen patients with MG were identified, giving the incidence of 3/10 000 live births. Mean age of the patients was 28 years, range 18 - 36 years. Average time since diagnosis was 9 years. Eleven women with MG delivered at term (one twin pregnancy), and two babies were born prematurely. In seven patients pregnancy was ended via normal spontaneous vaginal delivery (NSVD), one was forceps extraction, four patients had elective Cesarean Section (CS), and two had emergency CS. Indications for CS were purely obstetrical. Spontaneous vaginal deliveries were speedy. None of the patients had exacerbation of MG during current pregnancy. Mean birth weight of the newborns was 3014,3 g, range 1730 g to 3700 g. Mean Apgar score was 8,7 at 1 minute and 8,9 at 5 minutes. Only one neonate (second twin) developed Transient Neonatal Myasthenia Gravis (TNMG).

Myasthenia gravis did not have significant effect on the course of pregnancy or mode of delivery. In the twin pregnancies it is possible that only one twin will present with the symptoms of TNMG.