Myasthenia gravis in pregnancy: Systematic review and case series

Banner, Harrison; Niles, Kirsten M.; Ryu, Michelle; Sermer, Mathew; Bril, Vera; Murphy, Kellie

doi:10.1177/1753495x211041899

Cited by 20 publications

(22 citation statements)

References 36 publications

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“…It was further reported that there was a significant risk of women delivering through CS with Crohn’s disease (OR 1.65 (1.19–2.29)) but not as much with ulcerative colitis (OR 1.30 (0.86 to 1.96)) [ 33 , 34 , 112 ]. One of the reviews conducted a narrative analysis and reported women with myasthenia gravis are at increased risk of requiring assisted vaginal delivery or CS compared to women without the condition (population size = 854) [ 37 ].…”

Section: Resultsmentioning

confidence: 99%

“…Conditions like multiple sclerosis are known to have an adverse effect on pregnancy outcomes, but evidence is sparse to support this [ 29 , 36 ]. Some autoimmune conditions have been studied more than others with inconsistent findings [ 37 , 38 ]. This umbrella review aims to consolidate evidence from systematic reviews of the association of common autoimmune conditions with pregnancy outcomes in order to identify the strength and precision of these associations.…”

Section: Introductionmentioning

confidence: 99%

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Autoimmune diseases and adverse pregnancy outcomes: an umbrella review

Singh,

Wambua,

Lee

et al. 2024

BMC Med

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Background There is a high prevalence of autoimmune conditions in women specially in the reproductive years; thus, the association with adverse pregnancy outcomes has been widely studied. However, few autoimmune conditions/adverse outcomes have been studied more than others, and this umbrella review aims to consolidate existing knowledge in this area with the aim to provide new knowledge and also identify gaps in this research area. Methods Medline, Embase, and Cochrane databases were searched from inception to December 2023. Screening, data extraction, and quality appraisal (AMSTAR 2) were done by two independent reviewers. Data were synthesised narratively and quantitatively. Relative risks (RR)/odds ratio (OR) with 95% confidence intervals were reported. Results Thirty-two reviews were included consisting of 709 primary studies. The review reported the association between 12 autoimmune conditions and 16 adverse pregnancy outcomes. Higher risk of miscarriage is reported in women with Sjögren’s syndrome RR 8.85 (95% CI 3.10–25.26) and systemic lupus erythematosus (SLE) OR 4.90 (3.10–7.69). Pre-eclampsia was reported higher in women with type 1 diabetes mellitus (T1DM) OR 4.19 (3.08–5.71) and SLE OR 3.20 (2.54–4.20). Women reported higher risk of diabetes during pregnancy with inflammatory bowel disease (IBD) OR 2.96 (1.47–5.98). There was an increased risk of intrauterine growth restriction in women with systemic sclerosis OR 3.20 (2.21–4.53) and coeliac disease OR 1.71 (1.36–2.14). Preterm birth was associated with T1DM OR 4.36 (3.72–5.12) and SLE OR 2.79 (2.07–3.77). Low birth weight babies were reported in women with women with SLE or systemic sclerosis OR 5.95 (4.54–7.80) and OR 3.80 (2.16–6.56), respectively. There was a higher risk of stillbirth in women with T1DM OR 3.97 (3.44–4.58), IBD OR 1.57 (1.03–2.38), and coeliac disease OR 1.57 (1.17–2.10). T1DM in women was associated with 32% lower odds of small for gestational age baby OR 0.68 (0.56–0.83). Conclusions Pregnant women with autoimmune conditions are at a greater risk of developing adverse pregnancy outcomes. Further research is required to develop better preconception to postnatal care for women with autoimmune conditions.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Autoimmune diseases and adverse pregnancy outcomes: an umbrella review

Singh,

Wambua,

Lee

et al. 2024

BMC Med

View full text Add to dashboard Cite

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“…Rate of C-section was 38.3% in our cohort. Mode of delivery in MG patients shows great variability across studies that might be explained by geographical and temporal disparities as well as variances in the level of care provided by the hospitals where birth was given (5,7,18). A recent nationwide Swedish register-based cohort study found higher elective caesarian section rate in MG patients compared to matched controls (19).…”

Section: Resultsmentioning

confidence: 99%

Pregnancy in myasthenia gravis: A retrospective analysis of maternal and neonatal outcome from a large tertiary care center in Germany

Draxler,

Meisel,

Stascheit

et al. 2023

Preprint

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Purpose: Myasthenia gravis (MG) is a rare, potentially life-threatening autoimmune disease with fluctuating muscle weakness frequently affecting women of childbearing age. MG can affect maternal as well as neonatal outcome with risk of worsening of myasthenic symptoms in the mothers and risk of transient neonatal myasthenia gravis (TNMG) and arthrogryposis multiplex congenita (AMC) or fetal acetylcholine receptor antibody-associated disorders (FARAD) in the neonates. Methods: Retrospective analysis of maternal and neonatal outcome in a cohort of pregnant MG patients treated at a tertiary care center in Germany. Results: Overall, 66 pregnancies were analysed. During 40 (63%) pregnancies, women experienced a worsening of myasthenic symptoms, of whom 10 patients (15.7%) needed acute therapy with IVIg or plasma exchange. There was no case of myasthenic crisis. Rate of caesarian section was comparable to the overall C-section rate at our centre (38% vs. 40%). However, there was a slightly higher rate for operative vaginal delivery (15% vs. 10%) as potential indicator for fatiguing striated musculature in MG patients during the expulsion stage. Rate of TNMG as well as AMC was 3% (two cases each). Conclusions: Maternal and neonatal outcome in our cohort was favorable with a low rate of myasthenic exacerbations requiring acute therapies and a low rate of TNMG and AMC/FARAD. Our data might help neurologists and obstetricians to advice MG patients with desire to have children.

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“…Neonatal myasthenia occurs in around 10% of the newborn children of mothers with MG [ 8 , 36 ]. The babies have transient muscle weakness that rarely affects the respiratory muscles.…”

Section: Methodsmentioning

confidence: 99%

Myasthenia gravis, respiratory function, and respiratory tract disease

Gilhus

2023

J Neurol

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Myasthenia gravis (MG) is characterized by muscle weakness caused by autoantibodies that bind to the postsynaptic membrane at the neuromuscular junction and impair acetylcholine receptor function. Weakness of respiratory muscles represents the most severe MG manifestation, and 10–15% of all patients experience an MG crisis with the need of mechanical ventilatory support at least once in their life. MG patients with respiratory muscle weakness need active immunosuppressive drug treatment long term, and they need regular specialist follow-up. Comorbidities affecting respiratory function need attention and optimal treatment. Respiratory tract infections can lead to MG exacerbations and precipitate an MG crisis. Intravenous immunoglobulin and plasma exchange are the core treatments for severe MG exacerbations. High-dose corticosteroids, complement inhibitors, and FcRn blockers represent fast-acting treatments that are effective in most MG patients. Neonatal myasthenia is a transient condition with muscle weakness in the newborn caused by mother’s muscle antibodies. In rare cases, treatment of respiratory muscle weakness in the baby is required.

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Myasthenia gravis in pregnancy: Systematic review and case series

Cited by 20 publications

References 36 publications

Autoimmune diseases and adverse pregnancy outcomes: an umbrella review

Autoimmune diseases and adverse pregnancy outcomes: an umbrella review

Pregnancy in myasthenia gravis: A retrospective analysis of maternal and neonatal outcome from a large tertiary care center in Germany

Myasthenia gravis, respiratory function, and respiratory tract disease

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