Pregnancy and myasthenia gravis.
OBJECTIVE
Myasthenia gravis (MG) is an acquired autoimmune disorder characterized by fluctuating ocular, limb, or oropharyngeal muscle weakness due to an antibody-mediated attack at the neuromuscular junction. The female incidence of MG peaks in the third decade during the childbearing years. A number of exacerbating factors may worsen MG, including pregnancy. When treatment is needed, it must be carefully chosen with consideration of possible effects on the mother with MG, the pregnancy, and the fetus.


RESULTS
Decisions are complex in the treatment of women with MG contemplating pregnancy or with presentation during pregnancy. While data is largely observational, a number of characteristic patterns and issues related to risk to the patient, integrity of the pregnancy, and risks to the fetus are recognized. Familiarity with these special considerations when contemplating pregnancy is essential to avoid potential hazards in both the patient and the fetus. Use of immunosuppressive agents incurs risk to the fetus. Deteriorating MG with respiratory insufficiency poses risk to both the mother and the fetus.


CONCLUSIONS
This article reviews available information regarding expectations and management for patients with MG in the childbearing age. Treatment decisions must be individualized based on MG severity, distribution of weakness, coexisting diseases, and welfare of the fetus. Patient participation in these decisions is essential for successful management.
Janice M
JM
Massey
Carolina
C
De Jesus-Acosta
D000328:Adult; D018450:Disease Progression; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D009157:Myasthenia Gravis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000209:etiology* / Q000276:immunology; D011297:Prenatal Exposure Delayed Effects / Q000209:etiology
D007166:Immunosuppressive Agents