Pregnancy in Myasthenia Gravis: A Retrospective Analysis of Maternal and Neonatal Outcome from a Large Tertiary Care Centre in Germany

Authors: Draxler, J; Meisel, A; Stascheit, F; Stein, M; Gerischer, L; Mergenthaler, P; Herdick, M; Doksani, P; Lehnerer, S; Verlohren, S; Hoffmann, S

Affiliations: Charite Univ Med Berlin, Dept Neurol, Neurosci Clin Res Ctr NCRC, Charitepl 1, D-10117 Berlin, Germany. Charite Univ Med Berlin, Integrated Myasthenia Gravis Ctr, Charitepl 1, D-10117 Berlin, Germany. Free Univ Berlin, Charitepl 1, D-10117 Berlin, Germany. Humboldt Univ, Charitepl 1, D-10117 Berlin, Germany. Charite Univ Med Berlin, Berlin Inst Hlth, Charitepl 1, D-10117 Berlin, Germany. Charite Univ Med Berlin, Dept Obstet, Charitepl 1, D-10117 Berlin, Germany. Charite Univ Med Berlin, Ctr Stroke Res Berlin, Charite pl 1, D-10117 Berlin, Germany. Univ Oxford, Radcliffe Dept Med, Oxford, England.

Publication: Archives of Gynecology and Obstetrics; 2024

Abstract: 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 foetal 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 analyzed. 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 caesarean section was comparable to the overall C-section rate at our center (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.