Myasthenia gravis in pregnancy, disease course and outcome: Prospective observational study

Abstract

Background and objectives: Pregnant ladies with MG can have normal pregnancy and delivery, but the course is unpredictable,
however, worsening of symptoms occurs more likely during the first trimester and puerperium. Our aim was to follow up pregnant
women affected with myasthenia gravis (MG) to study the course of the disease, the extent of the disease sequelae, and the effect of
different treatment modalities on maternal and fetal outcomes. Methods: We conducted a prospective observational study regarding
treatment and follow-up for eighteen pregnant women with myasthenia gravis over a period of 20 years from 1999-2019 at the
department of obstetrics and gynecology of a tertiary university medical city, in Saudi Arabia. The course of the disease, during
pregnancy, mode of delivery, puerperium has been evaluated in addition to the state of the mother and the baby. Results: 66% of
females had spontaneous vaginal delivery. Three only experienced relapse during pregnancy (16.6%), one patient (5.5%) experienced
relapse in the puerperium, no patients had myasthenia crises, and six patients (33.3%) developed MG progression. One third of the
patients were treated with cholinesterase inhibitors alone, and the rest received corticosteroids. Fourteen patients (77.7%) had a
thymectomy. Four babies (22.2%) had transient neonatal myasthenia gravis. thymectomy in those females gave significantly different
results, P=0.015. Conclusion: Myasthenia gravis can be managed well during pregnancy with safe and effective therapies. Caesarian
section is recommended only for obstetrical reasons. Forceps and vacuum delivery are sometimes required. Myasthenia gravis
during pregnancy can lead to serious life threatening conditions. An interdisciplinary approach is required for managing pregnant
women with myasthenia gravis