Effect of pregnancy and birth on the course of myasthenia gravis before or after transsternal radical thymectomy.
OBJECTIVE
Myasthenia gravis (MG) affects women at childbearing age. Therefore, the question arises if these patients should become pregnant and if thymectomy has a positive effect on the course of MG in pregnant patients.


METHODS
Fifteen pregnancies had been followed retrospectively. All patients underwent transsternal radical thymectomy for MG. The course of MG in the period before, during, and after the pregnancy was scored according to Ossermann's classification. The effect of thymectomy on delivery and on the newborns was evaluated.


RESULTS
Patients were divided in two groups: pregnancies before (group I, n=8) and after (group II, n=7) thymectomy. During pregnancy, in group I, one deterioration was observed and in seven patients the disease was unchanged. In group II, one deterioration, five unchanged courses, and one improvement were observed. In the postpartum period, in group I, seven patients did not change and one improved. In group II, two deteriorations, three unchanged courses, and two improvements were observed. Before pregnancy, group II patients were in a better Ossermann stage in comparison with those in group I. Eight of the 12 deliveries were spontaneous (three abortus). Myasthenic symptoms were observed in two newborns in group I.


CONCLUSIONS
Our data suggest that MG is not prohibitive to have children. The course of MG after transsternal radical thymectomy is often ameliorated. A better MG-stage, reached after thymectomy, before pregnancy seems to be correlated with a better course during pregnancy.
Roth
Thierry Christophe
TC
Division of General Thoracic Surgery, University Hospital, 3010 Berne, Switzerland.
Raths
Janine
J
Carboni
Gianluca
G
Rösler
Kai
K
Schmid
Ralph Alexander
RA
D000328:Adult; D001942:Breast Feeding; D036861:Delivery, Obstetric; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000503:physiopathology / Q000601:surgery*; D049590:Postpartum Period; D011247:Pregnancy; D011248:Pregnancy Complications / Q000503:physiopathology / Q000601:surgery*; D011256:Pregnancy Outcome; D012074:Remission Induction; D012189:Retrospective Studies; D013934:Thymectomy