Myasthenia gravis and pregnancy: retrospective evaluation of 27 pregnancies in a tertiary center and comparison with previous studies


TANAÇAN A. , FADILOĞLU E. , ÖZTEN DERE G. , GÜNEŞ A. C. , ÖRGÜL G. , BEKSAÇ M. S.

IRISH JOURNAL OF MEDICAL SCIENCE, vol.188, no.4, pp.1261-1267, 2019 (Journal Indexed in SCI) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 188 Issue: 4
  • Publication Date: 2019
  • Doi Number: 10.1007/s11845-019-02029-0
  • Title of Journal : IRISH JOURNAL OF MEDICAL SCIENCE
  • Page Numbers: pp.1261-1267
  • Keywords: Acetylcholine receptors, Myasthenia gravis, Neuromuscular junction, Obstetric complications, Pregnancy, AUTOIMMUNE, CLASSIFICATION, GUIDELINES, MANAGEMENT, DELIVERY, MOTHERS, FETAL

Abstract

Background and aim To share our experience with the management of pregnancies in women with myasthenia gravis (MG) in a tertiary center. Methods The study retrospectively evaluated 27 pregnancies in 12 patients. The pregnancies were divided into 3 groups on the basis of the clinical course of MG during pregnancy: improvement (n = 7), disease-stable (n = 9), and deterioration (n = 11). The groups were compared with respect to patient characteristics, clinical features, and obstetric outcomes. Results There were 4 miscarriages (14.8%), 3 preterm births (11.1%), and 4 cases of preterm premature rupture of the membranes (PPROM) (14.8%). Exacerbation was observed in 25.9% of the cases; the remission rate during the postpartum period and after miscarriage was 37%. The cesarean section (CS) rate was 78.3%. Pregnancies with deterioration of MG were statistically more likely to have higher miscarriage, preterm birth, PPROM, CS, and transient neonatal MG rates, in addition to a lower gestational age at birth, birth weight, and 5-min Apgar score than pregnancies with improved or stable disease (p values < 0.001, 0.04, 0.03, 0.009, 0.02, < 0.001, 0.002, and 0.043, respectively). Conclusion Physicians who manage pregnant women with MG must be familiar with the clinical features of the condition; a multidisciplinary approach is necessary for a better prognosis.