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.
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.
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.
Address correspondence to Dr Janice M. Massey, Division of Neurology, Department of Medicine, Duke University Medical Center, DUMC 3403, Durham, NC 27710, Janice.firstname.lastname@example.org.
Relationship Disclosure: Dr Massey has received educational grants from Allergan, Inc; and Merz Pharma. Dr De Jesus-Acosta reports no disclosure.
Unlabeled Use of Products/Investigational Use Disclosure: Drs Massey and De Jesus-Acosta discuss the use of drugs for the treatment of myasthenia gravis, none of which are labeled by the US Food and Drug Administration for use in pregnancy.