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Myasthenia Gravis and Pregnancy

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Neurology and Psychiatry of Women

Abstract

Myasthenia gravis (MG) is an autoimmune disorder characterized by fluctuating and fatigable weakness of skeletal muscle. MG is more common in women than in men, particularly in the second and third decades of life, resulting in a relatively high burden of MG in women of child bearing age. The disease and its treatment side effects may have considerable impact on women’s general and reproductive health. Hormonal changes during pregnancy can influence the presentation and severity of MG. MG and its treatments also carry implications for the fetus. This chapter reviews the existing literature on the presentation, disease course, treatment and possible complications of MG in women, with a focus on pregnancy, labor and delivery.

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References

  1. Amato AA, Russell JA. Neuromuscular disorders. 2nd ed. New York: McGraw-Hill Medical; 2016.

    Google Scholar 

  2. Sanders DB, Wolfe GI, Benatar M, Evoli A, Gilhus NE, Illa I, et al. International consensus guidance for management of myasthenia gravis: executive summary. Neurology. 2016;87(4):419–25.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Cutolo M, Capellino S, Straub RH. Oestrogens in rheumatic diseases: friend or foe? Rheumatology (Oxford). 2008;47(Suppl 3):iii2–5.

    Google Scholar 

  4. Mays J, Butts CL. Intercommunication between the neuroendocrine and immune systems: focus on myasthenia gravis. Neuroimmunomodulation. 2011;18(5):320–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Leker RR, Karni A, Abramsky O. Exacerbation of myasthenia gravis during the menstrual period. J Neurol Sci. 1998;156(1):107–11.

    Article  CAS  PubMed  Google Scholar 

  6. Frenkel M. Treatment of myasthenia gravis by ovulatory suppression. Arch Neurol. 1964;11:613–7.

    Article  CAS  PubMed  Google Scholar 

  7. Stickler DE, Stickler LL. Single-fiber electromyography during menstrual exacerbation and ovulatory suppression in MuSK antibody-positive myasthenia gravis. Muscle Nerve. 2007;35(6):808–11.

    Article  PubMed  Google Scholar 

  8. Djelmis J, Sostarko M, Mayer D, Ivanisevic M. Myasthenia gravis in pregnancy: report on 69 cases. Eur J Obstet Gynecol Reprod Biol. 2002;104(1):21–5.

    Article  PubMed  Google Scholar 

  9. Delpy L, Douin-Echinard V, Garidou L, Bruand C, Saoudi A, Guery JC. Estrogen enhances susceptibility to experimental autoimmune myasthenia gravis by promoting type 1-polarized immune responses. J Immunol. 2005;175(8):5050–7.

    Article  CAS  PubMed  Google Scholar 

  10. Wu KH, Tobias ML, Kelley DB. Estrogen and laryngeal synaptic strength in Xenopus laevis: opposite effects of acute and chronic exposure. Neuroendocrinology. 2001;74(1):22–32.

    Article  CAS  PubMed  Google Scholar 

  11. Boldingh MI, Maniaol AH, Brunborg C, Weedon-Fekjaer H, Verschuuren JJ, Tallaksen CM. Increased risk for clinical onset of myasthenia gravis during the postpartum period. Neurology. 2016;87(20):2139–45.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Massey JM, De Jesus-Acosta C. Pregnancy and myasthenia gravis. Continuum (Minneap Minn). 2014;20(1):115–27.

    Google Scholar 

  13. Batocchi AP, Majolini L, Evoli A, Lino MM, Minisci C, Tonali P. Course and treatment of myasthenia gravis during pregnancy. Neurology. 1999;52(3):447–52.

    Article  CAS  PubMed  Google Scholar 

  14. Braga AC, Pinto C, Santos E, Braga J. Myasthenia gravis in pregnancy: experience of a portuguese center. Muscle Nerve. 2016;54(4):715–20.

    Article  CAS  PubMed  Google Scholar 

  15. Ducci RD, Lorenzoni PJ, Kay CS, Werneck LC, Scola RH. Clinical follow-up of pregnancy in myasthenia gravis patients. Neuromuscul Disord. 2017;27(4):352–7.

    Article  PubMed  Google Scholar 

  16. Norwood F, Dhanjal M, Hill M, James N, Jungbluth H, Kyle P, et al. Myasthenia in pregnancy: best practice guidelines from a U.K. multispecialty working group. J Neurol Neurosurg Psychiatry. 2014;85(5):538–43.

    Article  PubMed  Google Scholar 

  17. Ohlraun S, Hoffmann S, Klehmet J, Kohler S, Grittner U, Schneider A, et al. Impact of myasthenia gravis on family planning: how do women with myasthenia gravis decide and why? Muscle Nerve. 2015;52(3):371–9.

    Article  PubMed  Google Scholar 

  18. US Food and Drug Administration pregnancy categories, drug safety and availability. www.accessdata.fda.gov/scripts/cder/daf/. Accessed 15 Nov 2017.

  19. Park-Wyllie L, Mazzotta P, Pastuszak A, Moretti ME, Beique L, Hunnisett L, et al. Birth defects after maternal exposure to corticosteroids: prospective cohort study and meta-analysis of epidemiological studies. Teratology. 2000;62(6):385–92.

    Article  CAS  PubMed  Google Scholar 

  20. Carmichael SL, Shaw GM, Ma C, Werler MM, Rasmussen SA, Lammer EJ, et al. Maternal corticosteroid use and orofacial clefts. Am J Obstet Gynecol. 2007;197(6):585 e1–7. discussion 683–4, e1–7

    Article  CAS  Google Scholar 

  21. Hviid A, Molgaard-Nielsen D. Corticosteroid use during pregnancy and risk of orofacial clefts. CMAJ. 2011;183(7):796–804.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Skuladottir H, Wilcox AJ, Ma C, Lammer EJ, Rasmussen SA, Werler MM, et al. Corticosteroid use and risk of orofacial clefts. Birth Defects Res A Clin Mol Teratol. 2014;100(6):499–506.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Guidon AC, Massey EW. Neuromuscular disorders in pregnancy. Neurol Clin. 2012;30(3):889–911.

    Article  PubMed  Google Scholar 

  24. Clark AL. Clinical uses of intravenous immunoglobulin in pregnancy. Clin Obstet Gynecol. 1999;42(2):368–80.

    Article  CAS  PubMed  Google Scholar 

  25. Ciafaloni E, Massey JM. Myasthenia gravis and pregnancy. Neurol Clin. 2004;22(4):771–82.

    Article  PubMed  Google Scholar 

  26. Hehir MK, Hobson-Webb LD, Benatar M, Barnett C, Silvestri NJ, Howard JF Jr, et al. Rituximab as treatment for anti-MuSK myasthenia gravis: multicenter blinded prospective review. Neurology. 2017;89(10):1069–77.

    Article  CAS  PubMed  Google Scholar 

  27. Stieglbauer K, Pichler R, Topakian R. 10-year-outcomes after rituximab for myasthenia gravis: efficacy, safety, costs of inhospital care, and impact on childbearing potential. J Neurol Sci. 2017;375:241–4.

    Article  CAS  PubMed  Google Scholar 

  28. Wolfe GI, Kaminski HJ, Aban IB, Minisman G, Kuo HC, Marx A, et al. Randomized trial of thymectomy in myasthenia gravis. N Engl J Med. 2016;375(6):511–22.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Duley L. The global impact of pre-eclampsia and eclampsia. Semin Perinatol. 2009;33(3):130–7.

    Article  PubMed  Google Scholar 

  30. Lake AJ, Al Khabbaz A, Keeney R. Severe preeclampsia in the setting of myasthenia gravis. Case Rep Obstet Gynecol. 2017;2017:9204930.

    PubMed  PubMed Central  Google Scholar 

  31. Ozcan J, Balson IF, Dennis AT. New diagnosis myasthenia gravis and preeclampsia in late pregnancy. BMJ Case Rep. 2015;1–4.

    Google Scholar 

  32. Haider B, von Oertzen J. Neurological disorders. Best Pract Res Clin Obstet Gynaecol. 2013;27(6):867–75.

    Article  PubMed  Google Scholar 

  33. Hoff JM, Daltveit AK, Gilhus NE. Myasthenia gravis in pregnancy and birth: identifying risk factors, optimising care. Eur J Neurol. 2007;14(1):38–43.

    Article  CAS  PubMed  Google Scholar 

  34. Ahlsten G, Lefvert AK, Osterman PO, Stalberg E, Safwenberg J. Follow-up study of muscle function in children of mothers with myasthenia gravis during pregnancy. J Child Neurol. 1992;7(3):264–9.

    Article  CAS  PubMed  Google Scholar 

  35. O’Carroll P, Bertorini TE, Jacob G, Mitchell CW, Graff J. Transient neonatal myasthenia gravis in a baby born to a mother with new-onset anti-MuSK-mediated myasthenia gravis. J Clin Neuromuscul Dis. 2009;11(2):69–71.

    Article  PubMed  Google Scholar 

  36. Niks EH, Verrips A, Semmekrot BA, Prick MJ, Vincent A, van Tol MJ, et al. A transient neonatal myasthenic syndrome with anti-musk antibodies. Neurology. 2008;70(14):1215–6.

    Article  CAS  PubMed  Google Scholar 

  37. Lee JY, Min JH, Han SH, Han J. Transient neonatal myasthenia gravis due to a mother with ocular onset of anti-muscle specific kinase myasthenia gravis. Neuromuscul Disord. 2017;27(7):655–7.

    Article  PubMed  Google Scholar 

  38. Townsel C, Keller R, Johnson K, Hussain N, Campbell WA. Seronegative maternal ocular myasthenia gravis and delayed transient neonatal myasthenia gravis. AJP Rep. 2016;6(1):e133–6.

    Article  PubMed  PubMed Central  Google Scholar 

  39. D’Amico A, Bertini E, Bianco F, Papacci P, Jacobson L, Vincent A, et al. Fetal acetylcholine receptor inactivation syndrome and maternal myasthenia gravis: a case report. Neuromuscul Disord. 2012;22(6):546–8.

    Article  PubMed  Google Scholar 

  40. Hacohen Y, Jacobson LW, Byrne S, Norwood F, Lall A, Robb S, et al. Fetal acetylcholine receptor inactivation syndrome: a myopathy due to maternal antibodies. Neurol Neuroimmunol Neuroinflamm. 2015;2(1):e57.

    Article  PubMed  Google Scholar 

  41. Ressel G. AAP updates statement for transfer of drugs and other chemicals into breast milk. American Academy of Pediatrics. Am Fam Physician. 2002;65(5):979–80.

    PubMed  Google Scholar 

  42. American Academy of Pediatrics Committee on D. Transfer of drugs and other chemicals into human milk. Pediatrics. 2001;108(3):776–89.

    Article  Google Scholar 

  43. Wakata N, Nemoto H, Sugimoto H, Nomoto N, Konno S, Hayashi N, et al. Bone density in myasthenia gravis patients receiving long-term prednisolone therapy. Clin Neurol Neurosurg. 2004;106(2):139–41.

    Article  PubMed  Google Scholar 

  44. Pouwels S, de Boer A, Javaid MK, Hilton-Jones D, Verschuuren J, Cooper C, et al. Fracture rate in patients with myasthenia gravis: the general practice research database. Osteoporos Int. 2013;24(2):467–76.

    Article  CAS  PubMed  Google Scholar 

  45. Yeh JH, Chen HJ, Chen YK, Chiu HC, Kao CH. Increased risk of osteoporosis in patients with myasthenia gravis: a population-based cohort study. Neurology. 2014;83(12):1075–9.

    Article  PubMed  Google Scholar 

  46. Grossman JM, Gordon R, Ranganath VK, Deal C, Caplan L, Chen W, et al. American College of Rheumatology 2010 recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. Arthritis Care Res. 2010;62(11):1515–26.

    Article  Google Scholar 

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Correspondence to Mohammad Kian Salajegheh .

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Edmundson, C., Salajegheh, M.K. (2019). Myasthenia Gravis and Pregnancy. In: O’Neal, M. (eds) Neurology and Psychiatry of Women. Springer, Cham. https://doi.org/10.1007/978-3-030-04245-5_20

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  • DOI: https://doi.org/10.1007/978-3-030-04245-5_20

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  • Print ISBN: 978-3-030-04244-8

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