Myasthenia gravis in pregnancy: Experience of a portuguese center

Braga, António; Pinto, Clara; Santos, Ernestina; Braga, Jorge

doi:10.1002/mus.25095

Cited by 28 publications

(37 citation statements)

References 25 publications

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“…Although there are several studies indicating that maternal MG has a higher risk of preterm rupture of membrane, 4,5 MG by itself is not considered to raise the risk of any severe adverse pregnancy outcomes. 8,9 Reports do not suggest any increased risk of spontaneous abortions or premature births for women with MG. 8,10 Vaginal delivery is the first choice for patients with well-controlled MG because the uterine muscles are unaffected by the presence of acetylcholine receptor antibodies. 8,11 However, maternal voluntary muscle weakness can be exacerbated during expulsive efforts; thus, assistance might be required in the second stage using vacuum extraction.…”

Section: Discussionmentioning

confidence: 99%

“…Although there are several studies indicating that maternal MG has a higher risk of preterm rupture of membrane, MG by itself is not considered to raise the risk of any severe adverse pregnancy outcomes . Reports do not suggest any increased risk of spontaneous abortions or premature births for women with MG .…”

Section: Discussionmentioning

confidence: 99%

“…In a retrospective cohort study in Norway comparing 127 births by mothers with MG and 1.9 million births by mothers without MG, the rate of interventions during birth increased (33.9% vs. 20.0%, P < 0.0001) and cesarean sections doubled (17.3% vs 8.6%, P = 0.001) in MG mothers . In several retrospective studies, the cesarean section rate in MG mothers ranged from 30.7% to 66.7% . Indications for cesarean section in these studies were purely obstetrical.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Management of labor and delivery in myasthenia gravis: A new protocol

Tsurane

Tanabe

Matsuda

et al. 2019

J of Obstet and Gynaecol

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Aim Pregnancy with myasthenia gravis (MG) is known to be associated with an increased cesarean section rate, presumably due to maternal fatigue during labor. Although epidural labor analgesia (ELA) appears to be a good option for circumventing maternal fatigue, a protocol for managing MG deliveries has not been established. This study, based on a review of our case series, aimed to evaluate the validity of our management protocol for maternal MG, in which ELA is used depending on MG severity. Methods Parturients with systemic muscle weakness or worsening symptoms were classified as Category A (A), and those without symptoms were classified as Category B (B). In A, ELA was given at the onset of labor. Immediate vacuum delivery was done once the fetal head descended to station +2. For B, spontaneous vaginal delivery was chosen. The duration, blood loss, fetal weight, Apgar score and MG symptoms on post‐partum day (PPD) 1, 14 and 30 were recorded. Results Six patients were enrolled. Four were classified in A, and two were classified in B. No adverse events occurred during labor. Transvaginal delivery was successfully achieved in all the patients. Symptoms of MG were well‐controlled. MG symptoms were stable on PPD 1 in all the patients although two patients complained of worsening symptoms after PPD 14. Conclusion Women with MG can safely undergo spontaneous or operative vaginal delivery. ELA is a good option for circumventing the effects of maternal fatigue on delivery. Our protocol may lower the cesarean section rate in maternal MG.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Management of labor and delivery in myasthenia gravis: A new protocol

Tsurane

Tanabe

Matsuda

et al. 2019

J of Obstet and Gynaecol

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“…However, there are conflicting data regarding the period in pregnancy or postpartum when the risk of worsening is highest. [7][8][9][10] Sex hormones are suggested as triggers for worsening of symptoms. Estrogens do indeed enhance the immune response in mice models of MG. 11 In addition, maternal immunologic adaptation in pregnancy and pregnancy products such as a-fetoprotein are suggested as potential modulators of disease.…”

mentioning

confidence: 99%

“…Estrogens do indeed enhance the immune response in mice models of MG. 11 In addition, maternal immunologic adaptation in pregnancy and pregnancy products such as a-fetoprotein are suggested as potential modulators of disease. 12,13 Most studies of pregnancy in MG focus on the course and occurrence of neonatal MG, [7][8][9][10] but a few studies have reported the onset of myasthenia in this period. 14,15 Together with case reports, [16][17][18] these reports point to pregnancy and the postpartum period as a risk period for the start of the disease.…”

mentioning

confidence: 99%

Increased risk for clinical onset of myasthenia gravis during the postpartum period

et al. 2016

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Objective: To study the risk of clinical onset of myasthenia gravis (MG) in pregnancy and during the first 6 months postpartum because an association between pregnancy or the postpartum period and the onset of autoimmune MG is widely assumed but not proven. Methods:The design was a cross-sectional population-based cohort study of 2 MG cohorts (Norway and the Netherlands) with 1,038 healthy controls from Norway. Data were obtained on 246 women with MG (age at onset 15-45 years). Data on pregnancy, hormonal factors, and clinical symptoms were collected by a previously validated environmental MG questionnaire. Relative risk of MG onset before, during, and after pregnancy was calculated by multinomial logistic regression for Norwegian women reaching 45 years of age, adjusted for the observed distribution of person-years in the corresponding control group.Results: Of the included women with MG, 13 (11.5%) of the Dutch and 24 (18.0%) of the Norwegian patients had their first myasthenia symptoms during the pregnancy or postpartum period. The postpartum period was confirmed to be significantly associated with the onset of symptoms of MG in Norwegian women with MG (relative risk 5.5, 95% confidence interval 2.6-11.6). The risk was highest after the first childbirth. Autoimmune myasthenia gravis (MG) is hallmarked by fluctuating weakness, fatigability, thymic abnormalities, and antibodies that target proteins at the neuromuscular endplate such as the acetylcholine receptor (AChR) and muscle-specific kinase.1 The early-onset AChR MG subtype (EOMG) typically starts between 20 and 40 years of age and is characterized by a female preponderance (3:1) and thymus hyperplasia with germinal centers.2 EOMG is strongly associated with the haplotype human leukocyte antigen (HLA)-B*08/DRB1*03, but otherwise there are no well-established risk factors.

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Myasthenic crisis

Claytor

Cho

2023

Muscle and Nerve

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Myasthenic crisis (MC) is a life‐threatening manifestation of myasthenia gravis (MG) defined by respiratory insufficiency that requires the use of invasive or non‐invasive ventilation. This is often the result of respiratory muscle weakness but can also be due to bulbar weakness with upper airway collapse. MC occurs in approximately 15%–20% of patients with MG usually within the first 2 to 3 y of the disease course. Many crises have a specific trigger with respiratory infections being most common; however, no specific trigger is found in 30%–40% of patients. MG patients with a history of MC, severe disease, oropharyngeal weakness, muscle‐specific kinase (MuSK) antibodies and thymoma appear to be at higher risk. Most episodes of MC do not occur suddenly, providing a window of opportunity for prevention. Immediate treatment is directed toward airway management and removing any identified triggers. Plasmapheresis is preferred over intravenous immune globulin as the treatments of choice for MC. The majority of patients are able to be weaned from mechanical ventilation within 1 mo and the outcomes of MC are generally favorable. The mortality rate in United States cohorts is less than 5% and mortality in MC seems to be driven by age and other medical co‐morbidities. MC does not appear to affect long‐term prognosis as many patients are able to eventually achieve good MG control.

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Myasthenia gravis in pregnancy: Experience of a portuguese center

Abstract: A high rate of clinical worsening of MG in the mother was observed in this retrospective study, which highlights the importance of a multidisciplinary approach for avoiding maternal adverse outcomes. Muscle Nerve 54: 715-720, 2016.

Cited by 28 publications

References 25 publications

Management of labor and delivery in myasthenia gravis: A new protocol

Management of labor and delivery in myasthenia gravis: A new protocol

Increased risk for clinical onset of myasthenia gravis during the postpartum period

Myasthenic crisis

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