Management of Myasthenia Gravis During Pregnancy: A Report of Eight Cases

Abstract

Background: The clinical course of myasthenia gravis (MG) during pregnancy is highly variable and unpredictable. The management of MG in pregnancy has not been standardized.

Methods: Eight cases of MG in pregnancy, who were treated and gave birth in our hospital between 2004 and 2012, were retrospectively reviewed.

Results: In three patients, MG deteriorated during pregnancy. Three patients discontinued their medication for MG during their pregnancy, and the other five patients continued on corticosteroid or pyridostigmine. None of the infants showed any congenital abnormalities. Interestingly, there was a trend towards lower birth weight in infants born to women who had an exacerbation of MG during pregnancy. One patient who had unstable MG before pregnancy and voluntarily discontinued the medication for MG at the beginning of pregnancy, experienced MG exacerbation at the 30th week of pregnancy and gave birth prematurely to an infant with transient neonatal MG at the 34th week. The other seven patients had uneventful full-term pregnancy.

Conclusion: Women with unstable MG should postpone pregnancy to avoid potential risk of MG exacerbation and adverse effects on the fetus. Medication for MG should not be stopped abruptly during pregnancy, particularly for women with unstable MG. MG during pregnancy should be closely monitored and properly controlled.

Keywords: delivery; myasthenia gravis; neonatal myasthenia gravis; pregnancy; thymectomy; treatment.