Myasthenia gravis and pregnancy

Abstract

Myasthenia gravis (MG) is a chronic autoimmune disorder of neuromuscular transmission characterized by varying degrees of weakness and easy fatigability of the skeletal muscles. Precipitants of myasthenic symptoms or crises include physical and emotional stress, systemic illness, infections, hypo or hyperthyroidism, pregnancy, any type of surgery with general anaesthesia as well as corticosteroids. The authors report two cases of MG in pregnancy and discuss briefly the various aspects of the disease course and management in pregnancy. As MG occurs predominantly in women of reproductive years, it is important that obstetricians are aware of this condition and its management in pregnancy.

A Neuromusculer Disease Threatening Mother Life: Myasthenia Gravis

“…'ları MG'i provoke eden faktörleri; fiziksel ve duygusal stres, sistemik hastalık, infeksiyonlar, hipo veya hipertiroidi, gebelik, kortikosteroidler ve genel anestezi olarak bildirmişlerdir. 5 Hoff ve ark. 'ları MG'li hastaların gebelik komplikasyonlarının arttığını rapor etmişlerdir.…”

Acute Neurological Issues in Pregnancy and the Peripartum

“…Women are more commonly affected (2:1). 83 The course of MG during pregnancy is variable and varies with subsequent pregnancies. 84 Exacerbations occur in approximately 40% of pregnancies with the remainder of patients experiencing stable disease or remission of symptoms.…”

“…84 Exacerbations occur in approximately 40% of pregnancies with the remainder of patients experiencing stable disease or remission of symptoms. 83,85 Azathioprine can induce fetal leukopenia but is often maintained for severe disease. The management of preeclampsia in myasthenic patients presents a challenge as magnesium sulfate is contraindicated due to potential worsening of muscle weakness; and if seizures occur, Phenobarbital or Dilantin can be substituted.…”

“…The management of preeclampsia in myasthenic patients presents a challenge as magnesium sulfate is contraindicated due to potential worsening of muscle weakness; and if seizures occur, Phenobarbital or Dilantin can be substituted. 83 Close consultation with the obstetrical team and anesthesiology team should dictate the manner of delivery and anesthetics utilized. 83 Vaginal delivery is not contraindicated but a myasthenic patient may not be able to tolerate full labor due to fatigue.…”

“…83 Close consultation with the obstetrical team and anesthesiology team should dictate the manner of delivery and anesthetics utilized. 83 Vaginal delivery is not contraindicated but a myasthenic patient may not be able to tolerate full labor due to fatigue. 83 Following delivery, the infant must be closely evaluated for neonatal MG which occurs in approximately 10% to 20% of deliveries from placental transmission of acetylcholine antibodies and may be more prevalent in mothers who have not undergone thymectomy.…”