Management of myasthenia gravis during pregnancy

Abstract

The management of myasthenia gravis (MG) during pregnancy requires special skills as both diseases as well as its treatment can have deleterious effects on mother and fetus. MG often affects women in second and third decades of life during the childbearing age. Exacerbations of MG are likely to occur during the first trimester and postpartum period. The treatment of MG during pregnancy needs to be individualized depending on the severity of MG as well as the efficacy of various treatment modalities and their possible harmful effects on pregnancy. In addition, special attention has to be given to avoid drugs and other factors (such as urinary tract infections) which may worsen MG. The key to successful outcome during pregnancy in myasthenic women lies in multidisciplinary care involving obstetricians, neurologists, anesthetist as well as neonatologist. In this review, we discuss various therapeutic options available for the management of MG during pregnancy and provide recommendations based on the current best evidence.

Myasthenia gravis during pregnancy: what care should be taken?

“…Corticosteroids have been used for many years in pregnant women with other diseases. Their use has been correlated with increased risk of cleft palate (in a single study in which they were applied in the first trimester of pregnancy) 28 , increased incidence of gestational diabetes, hypertensive disease during pregnancy, urinary tract infection and premature delivery 29 . The recommendation is to use the lowest possible dose, in an effort to achieve the minimal manifestation state.…”

Neurocritical Care of the Pregnant Patient

“…A recent systematic review and meta-analysis pooled 96 studies with a total of 58,461 patients and reported the odds ratios for overall major congenital malformations, combined fetal losses, prenatal growth retardation, preterm birth, and other specific malformations. Overall, VPA, PHB, and PHT were associated with higher risk for major congenital malformations but LEV was not [ 67 ]. Given the physiological changes during pregnancy, therapeutic drug level monitoring should guide dose optimization for all AEDs.…”

Pregnancy with Myasthenia Gravis

“…In pregnant women with MG the incidence of premature rupture of membranes is three times more than pregnant women who do not suffer from MG. This is thought to be possible because of treatment using corticosteroids (Bansal, Goyal, & Modi, 2018).…”

“…MG treatments include Acetylcholinesterase inhibitors, Corticosteroids, Immunosuppressants, Plasmapheresis, Intravenous immunoglobulins, Thymectomy. The use of drugs in MG women who are pregnant or want to become pregnant are given individually based on the severity of the disease and the distribution of muscle weakness (Bansal et al, 2018).…”

“…(Thanvi, 2004) Plasmapharesis is safe for use in pregnant MG patients (Téllez-Zenteno et al, 2004). But in theory, plasmapheresis will increase the occurrence of preterm labor due to the loss of hormones in the circulation at the time of plasmapheresis (Bansal et al, 2018).…”