Myasthenia gravis (MG) can be associated with a wide array of risks in pregnancy and the clinical course can be unpredictable, according to a systematic literature review published in Cureus.
Across the studies the author reviewed, 30.4% of patients experienced symptom exacerbation; however, 8.753% of patients saw an improvement or stabilization of the disease during pregnancy. In patients with exacerbations, there was a 35.05% deterioration of conditions experienced by the patients.
A number of pregnancy-related complications were reported across the studies including spontaneous abortion, preterm delivery, and preterm premature rupture of membranes (PPROM). Most patients were able to deliver their children vaginally, however, a significant number of patients required a Caesarean section for delivery.
In terms of infant-related pregnancy outcomes, transient neonatal MG (TNMG), Down syndrome, deformity, erythroblastosis, and icterus were reported.
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The risk of complications does not appear to be significantly elevated for patients with MG during pregnancy compared to the general population, with the possible exception of PPROM, which was observed in 6.7% of cases in the literature review compared to a 3% risk in the general population.
Across the studies, a number of medications were commonly prescribed for MG including anticholinesterase drugs as well as prednisone, intravenous immunoglobulin (IVIg), and azathioprine.
“Given that this condition mainly affects fertile women, it is imperative to be knowledgeable about MG and the interdisciplinary diagnostic and therapeutic care it requires,” the authors wrote.
After identification and screening, 40 articles were included in the literature review. They included 15 retrospective case series and case reports, 16 reviews, and 4 retrospective cohort studies. Across all the studies spanning from 1967 to 2022, a total of 1322 women with MG and a total of 1604 pregnancies from multiple countries were included.
Kumar L, Kachhadia MP, Kaur J, et al. Choices and challenges with treatment of myasthenia gravis in pregnancy: a systematic review. Cureus. 2023;15(7). doi:10.7759/cureus.42772