Myasthenia Gravis and Pregnancy

Fraser, Donald; Jw, Turner

doi:10.1177/003591576305600523

Cited by 20 publications

(8 citation statements)

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“…As smooth muscle hypertrophy has never been described in newborn infants of myasthenic mothers having neostigmine, particularly in high doses (Stone and Rider, 1949;Tether, 1955;Fraser and Turner, 1963), we accept that smooth muscle hypertrophy in an infant born to a myasthenic mother so treated may be a chance combination. But in view of the pharmacological actions of neostigmine we consider that a large maternal dose of neostigmine (800 mg. daily) crossing the placenta to the foetus could explain the findings in this case.…”

Section: Neostigminementioning

confidence: 89%

Multiple smooth muscle hypertrophies in a newborn infant.

Cocker¹,

Thomson²

1966

Archives of Disease in Childhood

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Transient neonatal myasthenia gravis is a rare disease; it affects an estimated 15% of all babies born to myasthenic mothers. Since the condition was first described by Strickroot, Schaeffer, and Bergo (1942), reports have appeared in English of 42 patients, 4 of whom died in the neonatal period.Intestinal smooth muscle hypertrophy is extremely rare in infancy and childhood; to our knowledge only 2 cases have been recorded (Pritchard and Hillier, 1920;Guthrie, 1945). We present a further case of intestinal smooth muscle hypertrophy in an infant dying soon after delivery from a myasthenic mother who had been treated with large doses of neostigmine throughout pregnancy. A possible relationship between the two is considered.Case Report A woman of 37 who had been myasthenic since the age of 20 had a thymectomy when she was 22. Her first two pregnancies were terminated because of deterioration in her disease. The first and second trimesters of her third pregnancy were uneventful. She was admitted to St. Mary's Hospital at 36 weeks with ruptured membranes and draining slightly meconium-stained liquor, but not in labour. Her treatment was 45 mg. neostigmine hourly throughout pregnancy, pyridostigmine 60 mg. every 3-4 hours as required after admission, atropine 0 6 mg. orally with the first daily dose of neostigmine and once during the evening. A myasthenic crisis occurred, during which she stopped breathing, became cyanotic, and comatose. A period of anoxia ensued before a tracheostomy was performed, because of difficulty in maintaining an airway. She never regained consciousness and died 35 hours later. Necropsy showed multiple recent infarcts of the brain and thrombi in both arteries and veins supplying the infarcted areas.A limp cyanosed infant with a heart rate of 60 beats a minute was delivered by caesarean section 4 hours after the initial episode. Mucus and liquor were sucked out of the mouth and oxygen was given by face mask. Only 3 gasps occurred in the first 5 minutes, but despite an improvement in colour the heart rate remained the same; so the infant was intubated and oxygen was given by Received October 12, 1965. * Present address: Department of Pathology, Derbyshire Royal Infirmary, Derby. intermittent positive pressure. No further spontaneous respiration occurred. Neostigmine 0 -1 mg. and lobeline gr. 1/40 were given intravenously at 9 minutes with no response, the heart stopped at 15 minutes.Necropsy. The infant, weight 3 * 02 kg., crown heel length 49 cm., had no external evidence of disease. The cerebral white matter and meningeal vessels were moderately congested. The heart (42 g.) was enlarged to twice its normal weight because of gross hypertrophy and dilatation of the right ventricle and moderate hypertrophy of the left ventricle. The valves, septa, and great vessels were normal. The lungs were small (weight 27 g., expected weight 55 g.) and very congested. The left lung had interstitial emphysema on its cardiac surface.The peritoneal cavity contained amber fluid, and there was considerable retrop...

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Section: Neostigminementioning

confidence: 89%

Multiple smooth muscle hypertrophies in a newborn infant.

Cocker¹,

Thomson²

1966

Archives of Disease in Childhood

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“…Neostigmine is a quaternary ammonium compound with a half‐life of 15–30 min. In a report of six breast‐fed infants whose mothers were administered neostigmine for the treatment of myasthenia gravis, one newborn infant appeared to have abdominal cramps after a breast‐feeding episode; efforts to detect neostigmine in breast milk failed (; LOE 4). In a report of two infants whose mothers received pyridostigmine for the treatment of myasthenia gravis, the per kilogram dose of pyridostigmine ingested by the nursing infant was only 0.1% of that taken by the mother (maternal oral doses 180–300 mg·day −1 ) and was therefore considered safe for the breast‐feeding infant (; LOE 4, SOR D).…”

Section: Drugs Use In the Perioperative Periodmentioning

confidence: 99%

Safety of the breast‐feeding infant after maternal anesthesia

Dalal

Bosak²,

Berlin

2013

Pediatric Anesthesia

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There has been an increase in breast-feeding supported by the recommendations of the American Academy of Pediatrics and the World Health Organization. An anesthesiologist may be presented with a well-motivated breast-feeding mother who wishes to breast-feed her infant in the perioperative period. Administration of anesthesia entails acute administration of drugs with potential for sedation and respiratory effects on the nursing infant. The short-term use of these drugs minimizes the possibility of these effects. The aim should be to minimize the use of narcotics and benzodiazepines, use shorter acting agents, use regional anesthesia where possible and avoid agents with active metabolites. Frequent clinical assessments of the nursing infant are important. Available literature does suggest that although the currently available anesthetic and analgesic drugs are transferred in the breast milk, the amounts transferred are almost always clinically insignificant and pose little or no risk to the nursing infant.

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“…Metoclopramide has been used to promote lactation in breastfeeding mothers and no adverse impact on infants has been reported [14][15][16] . Xenon 2 and neostigmine 7 are undetectable in human breastmilk after their administration to lactating mothers. Heparin does not cross into breastmilk 17 , while glycopyrrolate 18 , nitrous oxide 18 and isoflurane 12 have negligible transfer.…”

Section: Drugs With No Milk Transfer or Safety Verified By Targeted Smentioning

confidence: 99%

Breastfeeding after Anaesthesia: A Review of the Pharmacological Impact on Children

Chu

McCallum

Yii

2013

Anaesth Intensive Care

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Post-anaesthetic advice imparted to breastfeeding mothers can vary. This is due in part to the differing information from published data, product information sheets and inevitably from the unhindered flow of opinions available on the internet. This literature review examined the evidence relating to drugs commonly used in the modern anaesthetic setting and their impact on breastfed children. It suggests that special precautions are rarely warranted in the post-anaesthetic care of breastfeeding patients.

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Myasthenia Gravis and Pregnancy

Cited by 20 publications

References 0 publications

Multiple smooth muscle hypertrophies in a newborn infant.

Multiple smooth muscle hypertrophies in a newborn infant.

Safety of the breast‐feeding infant after maternal anesthesia

Breastfeeding after Anaesthesia: A Review of the Pharmacological Impact on Children

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