MuSK myasthenia gravis and pregnancy

Santos, Ernestina; Braga, António; Gabriel, Denis; Duarte, Sara; Silva, Ana Martins da; Matos, Ilda; Freijo, Marta; Martins, João; Silveira, Fernando; Nadais, Goreti; Sousa, Filipa; Fraga, Carla; Silva, Rosa Santos; Lopes, Carlos; Gonçalves, Guilherme; Pinto, Clara; Braga, Jorge; Leite, Maria Isabel

doi:10.1016/j.nmd.2017.11.014

Cited by 20 publications

(21 citation statements)

References 24 publications

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“…Mother Deterioration during pregnancy 0-50% (Ducci et al 101 ; Batocchi et al 102 ; Tanacan et al 103 ; Tellez-Zenteno et al 104 ; Santos et al 105 ; Hoff et al 106 101,104,112,113 A single case of neonatal myasthenic syndrome in the newborn of a mother with localised (ocular) seronegative MG has been reported. 114 Antibodies against AChR, MuSK and LRP4 were shown to be detectable in the newborn's circulation with and without neonatal MG. 115,116 Thus, distinct factors like binding affinity to the foetal type of AChR seem to determine whether neonatal myasthenic symptoms occur or not.…”

Section: Type Of Complication Frequency (%)mentioning

confidence: 99%

See 1 more Smart Citation

Gender issues of antibody-mediated diseases in neurology: (NMOSD/autoimmune encephalitis/MG)

Altıntaş

Dargvainiene

Schneider‐Gold

et al. 2020

Ther Adv Neurol Disord

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Neuromyelitis optica spectrum disorder (NMOSD), autoimmune encephalitis (AE), myasthenia gravis (MG) and Lambert-Eaton myasthenic syndrome (LEMS) are antibody-mediated neurological diseases. They have mostly female predominance, affecting many women during childbearing age. Interactions between the underlying disease (or necessary treatment) and pregnancy can occur in every of these illnesses. Herein, we present the characteristics of NMOSD, AE, MG and LEMS in general, and review published data regarding the influence of the different diseases on fertility, pregnancy, puerperium, treatment strategy during pregnancy and post-partum period, and menopause but also male factors. We summarise key elements that should be borne in mind when confronted with such cases.

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Section: Type Of Complication Frequency (%)mentioning

confidence: 99%

“…One case of transient neonatal myasthenic syndrome occurred in the group of patients with MG onset before pregnancy. 105 …”

Section: Myasthenia Gravis and Lambert-eaton Myasthenic Syndrome And mentioning

confidence: 99%

Gender issues of antibody-mediated diseases in neurology: (NMOSD/autoimmune encephalitis/MG)

Altıntaş

Dargvainiene

Schneider‐Gold

et al. 2020

Ther Adv Neurol Disord

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“…In the postpartum period, however, there is an increased risk for both debut of MG and MG deterioration. Among 27 pregnancies either before or during MG with MuSK antibodies, the pregnancy and puerperium did not precipitate or influence mother's muscle weakness (19).…”

Section: Mother's Mgmentioning

confidence: 80%

Myasthenia Gravis Can Have Consequences for Pregnancy and the Developing Child

Gilhus

2020

Front. Neurol.

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Myasthenia gravis (MG) with onset below 50 years, thymic hyperplasia and acetylcholine receptor (AChR) antibodies is more common in females than in males. For a relatively large group of MG patients, pregnancy represents therefore an important question. The muscle weakness, the circulating autoantibodies, the hyperplastic thymus, the MG drug treatment, and any autoimmune comorbidity may all influence both mother and child health during pregnancy and also during breastfeeding in the postpartum period. Mother's MG remains stable in most patients during pregnancy. Pyridostigmine, prednisolone, and azathioprine are regarded as safe during pregnancy. Mycophenolate, methotrexate and cyclophosphamide are teratogenic and should not be used by women with the potential to become pregnant. Rituximab should not be given during the last few months before conception and not during pregnancy. Intravenous immunoglobulin and plasma exchange can be used for exacerbations or when need for intensified therapy. Pregnancies in MG women are usually without complications. Their fertility is near normal. Vaginal delivery is recommended. MG patients have an increased rate of Cesarean section, partly due to their muscle weakness and to avoid exhaustion, partly as a precaution that is often unnecessary. Around 10% of the newborn develop neonatal myasthenia during the first few days after birth. This is transient and usually mild with some sucking and swallowing difficulties. In rare cases, transplacental transfer of AChR antibodies leads to permanent muscle weakness in the child, and arthrogryposis with joint contractures. Repeated spontaneous abortions have been described due to AChR antibodies. MG women should always give birth at hospitals with experience in newborn intensive care. MG does not represent a reason for not having children, and the patients should be supported in their wish of becoming pregnant.

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“…Respiratory involvement and disease crises are a risk. One Portuguese series retrospectively examined the pregnancy course in 17 MuSK positive women, of which 13 had more than one pregnancy (27 total pregnancies studied) ( Santos et al, 2018 ). All were on steroids at the time of conception, one on azathioprine and another on IVIg maintenance infusions.…”

Section: Neuromuscular Junction Disordersmentioning

confidence: 99%

“…Fixed weakness starting at variable ages, ranging from early childhood to the old age, is characteristic. There are a growing number of reports detailing successful pregnancies during ongoing enzyme replacement ( Kłos et al, 2017 ; Santos et al, 2018 ; Van Houtte and De Bleecker, 2019 ). No specific complications were noted.…”

Section: Muscle Disordersmentioning

confidence: 99%

Neuromuscular disorders in pregnancy

Weimer

2020

Handbook of Clinical Neurology

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Many neuromuscular disorders preexist or occur during pregnancy. In some cases, pregnancy unmasks a latent hereditary disorder. Most available information is based on case reports or series or retrospective clinical experience or patient surveys. Of special interest are pregnancy-induced changes in disease course or severity and likelihood for baseline recovery of function postpartum. Labor and delivery present special challenges in many conditions that affect skeletal but not smooth (uterine) muscle; so labor complications must be anticipated. Anesthesia for cesarean section surgery requires special precautions in many disorders. The types of conditions reviewed are broad and include examples of autoimmune, hereditary, and compressive/mechanical processes. Disorders include carpal tunnel syndrome and other focal neuropathies, Bell palsy, myasthenia gravis, and other neuromuscular junction disorders, acute and chronic inflammatory neuropathy, hereditary and acquired muscle diseases, spinal muscular atrophy, amyotrophic lateral sclerosis, channelopathies, autonomic neuropathy, and dysautonomia. Many commonly used therapies have fetal animal but no proven human toxicity concerns, complicating treatment and risk decisions. Weaning off effective therapeutic agents or preemptive aggressive treatment or surgery prior to planned pregnancy is an option in some conditions.

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MuSK myasthenia gravis and pregnancy

Cited by 20 publications

References 24 publications

Gender issues of antibody-mediated diseases in neurology: (NMOSD/autoimmune encephalitis/MG)

Gender issues of antibody-mediated diseases in neurology: (NMOSD/autoimmune encephalitis/MG)

Myasthenia Gravis Can Have Consequences for Pregnancy and the Developing Child

Neuromuscular disorders in pregnancy

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