Myasthenia gravis and pregnancy: a systematic review and meta-analysis

Myasthenia gravis (MG) is an autoimmune disease with an onset age distribution in women, which peaks within the reproductive age range, leading to a potential interference with pregnancy. In this systematic review, we aim to assess the impact of pregnancy on the course of MG during pregnancy and postpartum period and to identify potential risk factors influencing the postpartum course.

A systematic literature search was conducted in the two databases PubMed and Epistemonikos on the topic "Myasthenia gravis and pregnancy" in October 2025. We included cohort studies and case series with at least 5 cases, reporting the clinical course of MG in women during pregnancy or postpartum period. Quality assessment was performed using the Critical Appraisal Skills Programme (CASP) tool for cohort studies.

In total, 34 studies were included, covering 3720 pregnancies in women with MG. Of 842 pregnancies worsening myasthenic symptoms was reported in 30% of pregnancies most frequently in the first trimester. Postpartum exacerbations were observed in 27% of the cases. However, incidence of worsening and scoring systems differed vastly. Preterm birth was reported at a rate of 9%. Vaginal delivery and cesarean section were performed in 68% and 32% respectively. Of 1530 infants, 9% developed neonatal myasthenia gravis.

This review confirms that symptom worsening is most common in the first trimester or postpartum. Women with MG were more likely to require cesarean section or operative vaginal delivery compared to general population data. However, the studies' quality varied widely. Prospective studies are needed to better identify risk factors for complicative course during pregnancy and postpartum period.