Intravenous immunoglobulin as monotherapy for myasthenia gravis during pregnancy

Gamez, Josep; Salvadó, María; Casellas, M.; Manrique, Susana; Castillo, Félix

doi:10.1016/j.jns.2017.10.037

Cited by 16 publications

(16 citation statements)

References 72 publications

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“…With PE, monitoring for hypotension, infection, and fluid shift is recommended. No increase in adverse effects is seen with either procedure during pregnancy 48‐51 …”

Section: Impact Of Mg On Pregnancymentioning

confidence: 99%

Myasthenia gravis and pregnancy

Grover

Sripathi

2020

Muscle and Nerve

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Myasthenia gravis (MG) is an autoimmune disorder with bimodal age of presentation, occurring in young women of reproductive age and at an older age in men. Occasionally, MG is diagnosed during pregnancy. Management of MG includes symptomatic treatment with cholinesterase inhibitors and immunosuppressive therapy for controlling the disease activity. Treatment of MG in women of reproductive age, who may be contemplating pregnancy, requires discussion regarding the choice of medication as well as the understanding of risks/adverse effects involved with various treatments. During the peripartum period, it is essential to ensure careful monitoring of the disease state along with the well-being of the mother and fetus and to coordinate neonatal monitoring overseen by a multidisciplinary team comprising a high-risk maternal fetal medicine specialist, a neurologist familiar with these complex issues, and a neonatologist.

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“…With PE, monitoring for hypotension, infection, and fluid shift is recommended. No increase in adverse effects is seen with either procedure during pregnancy 48‐51 …”

Section: Impact Of Mg On Pregnancymentioning

confidence: 99%

Myasthenia gravis and pregnancy

Grover

Sripathi

2020

Muscle and Nerve

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“…Finally, the risk of transient neonatal myasthenia gravis in individual studies has ranged from 0% 18,26,36,37,47 to 33.3% 34,39,42 . In our large sample, the overall rate was 89/686 (13.0%).…”

Section: Discussionmentioning

confidence: 99%

“…The proportion of patients with a thymectomy prior to pregnancy ranged from 16.7% 36 to 100% 37,39 . Across studies, the majority of patients were treated with anti-cholinesterase medications during pregnancy, though a significant number also required prednisone 34,40,47 .…”

Section: Mg Treatment In Pregnancymentioning

confidence: 99%

Myasthenia Gravis in Pregnancy: Case Series and Systematic Review

Banner¹,

Niles²,

Ryu³

et al. 2020

Preprint

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Background: Myasthenia gravis (MG) is an autoimmune disease which can affect reproductive-aged women and impact pregnancy outcomes. Objectives: To systematically review pregnancy outcomes for patients with MG. Search Strategy: Ovid MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, PubMed (Non-Medline records), Web of Science, and LILACS databases were systematically searched for pregnancies complicated by MG. Selection Criteria: Human studies of five or more subjects reporting outcomes of MG in pregnancy published in any language. Data Collection and Analysis: Following identification and review of relevant studies, data on study characteristics, MG subtypes, treatment, disease and pregnancy outcomes were extracted. Assessment of bias was performed using the National Institutes of Health Quality Assessment Tool for Case Series. In addition, cases of MG in pregnancy managed at our centre were identified and outcomes included in the analysis. Main Results: In total, 32 publications met inclusion criteria for systematic review, for a total of 33 unique data sets including 48 cases at our institution. In total, outcome data was available for 824 pregnancies complicated by MG. Overall risk of MG exacerbation was 33.8% with a 6.4% risk of myasthenic crisis in pregnancy and 8.2% postpartum. Spontaneous vaginal delivery occurred in 56.3% of pregnancies. The risk of transient neonatal myasthenia gravis (TNMG) was 13.0%. Conclusions: One third of pregnant MG patients will experience an exacerbation with 6.4% and 8.2% experiencing myasthenic crisis in pregnancy and postpartum respectively. More than half of MG patients had a spontaneous vaginal birth. The risk of TNMG is 13%

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“…Approximately, one-third experience improvement, one-third no change or worsening, and one-third experience a myasthenic crisis (MC). First-line treatment during pregnancy is oral pyridostigmine [ 68 , 69 ]. Intravenous acetylcholinesterase inhibitors should be avoided as they can induce uterine contractions.…”

Section: Medical and Surgical Managementmentioning

confidence: 99%

“…Intravenous acetylcholinesterase inhibitors should be avoided as they can induce uterine contractions. It is well established that plasma exchange and/or IVIG can be deployed for prompt, transient use in MC and both are safe in pregnancy [ 68 , 69 , 70 •].…”

Section: Medical and Surgical Managementmentioning

confidence: 99%

Neurocritical Care of the Pregnant Patient

Malaiyandi

James

Peglar

et al. 2021

Curr Treat Options Neurol

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Purpose of review To summarize recent changes in management and emerging therapies for pregnant neurocritical care patients. Recent findings Diagnostic and treatment options for managing neurologic emergencies in pregnant patients have expanded with both greater understanding of the effects of imaging modalities and medications on pregnancy and application of standard treatments for non-pregnant patients to pregnant populations. Specifically, this includes cerebrovascular diseases (pregnancy-associated ischemic stroke, pregnancy-associated intracerebral hemorrhage, cerebral venous sinus thrombosis), post-maternal cardiac arrest care, seizures and status epilepticus, myasthenia gravis, and fetal somatic support in maternal death by neurologic criteria. Summary With the exception of direct abdominal computed tomography (CT), most imaging studies are reasonably safe in pregnancy. When emergent imaging is needed to prevent maternal morbidity or mortality, any CT sequence with or without contrast is appropriate to pursue. Though new safety data on antiplatelets, antihypertensives, thrombolytics, and antiepileptic drugs have increased options for disease management in pregnancy, unfractionated and low-molecular weight heparin remain the safest options for anticoagulation. Early studies on hypothermia, ketamine, and immunomodulating therapies in pregnancy are promising. In myasthenia gravis, new data on adjunct devices may allow more patients to undergo safe vaginal delivery, avoiding cesarean section and the associated risk of crisis. When difficult decisions regarding preterm delivery arise, recent outcome studies can help inform discussion. Lastly, when the feared complication of maternal death by neurologic criteria occurs, fetal somatic support may help to save at least one life.

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Intravenous immunoglobulin as monotherapy for myasthenia gravis during pregnancy

Cited by 16 publications

References 72 publications

Myasthenia gravis and pregnancy

Myasthenia gravis and pregnancy

Myasthenia Gravis in Pregnancy: Case Series and Systematic Review

Neurocritical Care of the Pregnant Patient

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