title: Myasthenia in pregnancy: best practice guidelines from a U.K. multispecialty working group.
abstract: A national U.K. workshop to discuss practical clinical management issues related to pregnancy in women with myasthenia gravis was held in May 2011. The purpose was to develop recommendations to guide general neurologists and obstetricians and facilitate best practice before, during and after pregnancy. The main conclusions were (1) planning should be instituted well in advance of any potential pregnancy to allow time for myasthenic status and drug optimisation; (2) multidisciplinary liaison through the involvement of relevant specialists should occur throughout pregnancy, during delivery and in the neonatal period; (3) provided that their myasthenia is under good control before pregnancy, the majority of women can be reassured that it will remain stable throughout pregnancy and the postpartum months; (4) spontaneous vaginal delivery should be the aim and actively encouraged; (5) those with severe myasthenic weakness need careful, multidisciplinary management with prompt access to specialist advice and facilities; (6) newborn babies born to myasthenic mothers are at risk of transient myasthenic weakness, even if the mother's myasthenia is well-controlled, and should have rapid access to neonatal high-dependency support.
authors.affiliation: Department of Neurology, Ruskin Wing, King's College Hospital, Denmark Hill, , London, UK.
authors.forename: Fiona
authors.initials: F
authors.lastname: Norwood
authors.forename: Mandish
authors.initials: M
authors.lastname: Dhanjal
authors.forename: Marguerite
authors.initials: M
authors.lastname: Hill
authors.forename: Natalie
authors.initials: N
authors.lastname: James
authors.forename: Heinz
authors.initials: H
authors.lastname: Jungbluth
authors.forename: Pippa
authors.initials: P
authors.lastname: Kyle
authors.forename: Geraldine
authors.initials: G
authors.lastname: O'Sullivan
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Palace
authors.forename: Stephanie
authors.initials: S
authors.lastname: Robb
authors.forename: Catherine
authors.initials: C
authors.lastname: Williamson
authors.forename: David
authors.initials: D
authors.lastname: Hilton-Jones
authors.forename: Catherine
authors.initials: C
authors.lastname: Nelson-Piercy
mesh_terms: D000293:Adolescent; D000328:Adult; D002985:Clinical Protocols; D036861:Delivery, Obstetric; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007231:Infant, Newborn; D009157:Myasthenia Gravis / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D011295:Prenatal Care / Q000458:organization & administration*; D006113:United Kingdom; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents
keywords: MYASTHENIA