Myasthenia gravis and pregnancy

Area of Science:

• Neurology
• Obstetrics
• Immunology

Background:

• Myasthenia gravis (MG) presents unique challenges during pregnancy.
• Physiological changes in pregnancy necessitate careful monitoring for MG exacerbations.

Purpose of the Study:

• To outline management strategies for pregnant patients with myasthenia gravis.
• To discuss considerations for fetal well-being and neonatal outcomes in MG pregnancies.

Main Methods:

• Review of current literature and clinical guidelines for managing myasthenia gravis during pregnancy.
• Discussion of preconceptional counseling, antenatal, intrapartum, and postpartum care.
• Exploration of pharmacological and non-pharmacological interventions.

Main Results:

• Preconceptional counseling is crucial for optimizing medication, ideally reducing corticosteroids.
• Antenatal testing interpretation can be challenging; fetal MG is rare but detectable.
• Interventions like corticosteroids, azathioprine, or plasmapheresis may be used to reduce fetal antibody transfer.
• Epidural anesthesia and assisted delivery can manage intrapartum fatigue and labor.
• Neonatal myasthenia affects up to 21% of infants, regardless of maternal antibody levels.

Conclusions:

• Pregnancy is a viable option for MG patients with appropriate multidisciplinary care.
• Continuous assessment and individualized management are key throughout pregnancy and postpartum.
• Neonatal outcomes require vigilance and prompt management of potential transient neonatal myasthenia.