Pregnancy and Myasthenia Gravis

  • A. P. Batocchi
Part of the Topics in Neuroscience book series (TOPNEURO)


Pregnancy is an immunological balancing act in which the mother’s immune system has to remain tolerant of paternal major histocompatibility (MHC) antigens while maintaining normal immune competence for defence against microorganisms.


Systemic Lupus Erythematosus Myasthenic Patient Fetoplacental Unit Acetylcholine Receptor Antibody Maternal Peripheral Blood 
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  1. 1.
    Weetman AP (1999) The immunology of pregnancy. Thyroid 9:643–646PubMedCrossRefGoogle Scholar
  2. 2.
    Wegmann TG, Lin H, Guilbert L, Mosmann TR (1993) Bidirectional cytokine interactions in the maternal-fetal relationship: is successful pregnancy a Th2 phenomenon? Immunol Today 14:353–356PubMedCrossRefGoogle Scholar
  3. 3.
    Raghupathy R (1997) Th1-type immunity is incompatible with successful pregnancy. Immunol Today 18:478–482PubMedCrossRefGoogle Scholar
  4. 4.
    Saito S, Tsukaguchi N, Hasegawa T et al (1999) Distribution of Th1, Th2, and Th0 and the Th1/Th2 cell ratios in human peripheral and endometrial T cells. Am J Reprod Immunol 42:240–245PubMedCrossRefGoogle Scholar
  5. 5.
    Lim KJH, Odukoya OA, Ajjan RA et al (2000) The role of T-helper cytokines in human reproduction. Fertility Sterility 73:136–142CrossRefGoogle Scholar
  6. 6.
    Reinhard G, Noll A, Schlebusch H et al (1998) Shifts in the TH1/TH2 balance during human pregnancy correlate with apoptotic changes. Biochem Biophys Res Commun 245:933–988PubMedCrossRefGoogle Scholar
  7. 7.
    Saito S, Sakai M, Tanebe K et al (1999) Quantitative analysis of peripheral blood Th0, Th1, Th2 and the Th1:Th2 cell ratio during normal human pregnancy and preeclampsia. Clin Exp Immunol 117:550–555PubMedCrossRefGoogle Scholar
  8. 8.
    Kim S, Liva SM, Dalai MA et al (1999) Estriol ameliorates autoimmune demyelinating disease. Implications for multiple sclerosis. Neurology 52:1230–1238PubMedCrossRefGoogle Scholar
  9. 9.
    Leker RR, Karni A, Brenner T et al (2000) Effects of sex hormones on experimental autoimmune myasthenia gravis. Eur J Neurol 7:203–206PubMedCrossRefGoogle Scholar
  10. 10.
    Neidhart M (1998) Prolactin in autoimmune diseases Proc Soc Exp Biol Med 217:408–419PubMedGoogle Scholar
  11. 11.
    Vincent A, Newson-Davis J (1985) Acetylcholine receptor antibody as a diagnostic test for myasthenia gravis: results in 153 validated cases and 2967 diagnostic assays. J Neurol Neurosurg Psychiatry 48:1246–1252PubMedCrossRefGoogle Scholar
  12. 12.
    Evoli A, Batocchi AP, Lo Monaco M et al (1996) Clinical heterogeneity of seronegative myasthenia gravis. Neuromusc Disord 6:155–161PubMedCrossRefGoogle Scholar
  13. 13.
    Zhang G, Navikas V, Link H (1997) Cytokines and the pathogenesis of myasthenia gravis. Muscle Nerve 20:543–551PubMedCrossRefGoogle Scholar
  14. 14.
    Balasa B, Sarvetnick N (2000) Is pathogenic humoral autoimmunity a Th1 response? Lessons from (for) myasthenia gravis. Immunol Today 21:19–23PubMedCrossRefGoogle Scholar
  15. 15.
    Balasa B, Deng C, Lee J et al (1997) Interferon gamma (IFN-gamma) is necessary for the genesis of acetylcholine receptor-induced clinical experimental autoimmune myasthenia gravis in mice. J Exp Med 4:385–391CrossRefGoogle Scholar
  16. 16.
    Balasa B, Deng C, Lee J et al (1998) The Th2 cytokine IL-4 is not required for the progression of antibody-dependent autoimmune myasthenia gravis. J Immunol 161:2856–2862PubMedGoogle Scholar
  17. 17.
    Saoudi A, Bernard I, Hoedemaekers A et al (1999) Experimental autoimmune myasthenia gravis may occur in the context of a polarized Th1- or Th2-type immune response in rats. J Immunol 162:7189–7197PubMedGoogle Scholar
  18. 18.
    Oosterhuis HJGH (1997) Myasthenia gravis. Groningen Neurological Press, GroningenGoogle Scholar
  19. 19.
    Planché WC (1991) Myasthenia gravis in mothers and their newborns. Clin Obstet Gynecol 34:82–99CrossRefGoogle Scholar
  20. 20.
    Eymard B, Morel E, Dulac O et al (1989) Myasthénie et grossesse: une étude clinique et immunologique de 42 cas. Rev Neurol (Paris) 145:696–701Google Scholar
  21. 21.
    Batocchi AP, Majolini L, Evoli A et al (1999) Course and treatment of myasthenia gravis during pregnancy. Neurology 52:447–452PubMedCrossRefGoogle Scholar
  22. 22.
    Wechsler B, Le Thi Huong D, Piette JC (1999) Pregnancy and systemic lupus erythematosus. Ann Med Interne (Paris) 150:408–418Google Scholar
  23. 23.
    Donaldson JO, Penn AS, Lisak RP et al (1981) Antiacetylcholine receptor antibody in neonatal myasthenia gravis. Am J Dis Child 135:222–225PubMedGoogle Scholar
  24. 24.
    Lefvert AK, Osterman PO (1983) Newborn infants to myasthenic mothers: a clinical study and an investigation of acetylcholine receptor antibodies in 17 children. Neurology 33:133–138PubMedCrossRefGoogle Scholar
  25. 25.
    Giacoia CP, Azubuike K (1991) Autoimmune diseases in pregnancy: their effect on the fetus and newborn. Obstet Gynecol Surv 46:723–732PubMedGoogle Scholar
  26. 26.
    Harris RE (1978) Maternal and fetal immunology. Obstet Gynecol 51:733–739PubMedGoogle Scholar
  27. 27.
    Camus M, Clouard C (1989) Myasthénie et grossesse: à propos de 8 cas. J Gynecol Obstet Biol Reprod 18:904–911Google Scholar
  28. 28.
    Melber D (1988) Maternal-fetal transmission of myasthenia gravis with negative acetylcholine receptor antibody. N Engl J Med 318:996PubMedGoogle Scholar
  29. 29.
    Bassan H, Muhlbauer B, Tomer A, Spirer Z (1998) High dose intravenous immunoglobulin in the management of transient neonatal myasthenia gravis. Pediatr Neurol 18:181–183PubMedCrossRefGoogle Scholar
  30. 30.
    Tagher RJ, Baumann R, Desai N (1999) Failure of intravenously administered immunoglobulin in the treatment of neonatal myasthenia gravis. J Pediatr 134:233–235PubMedCrossRefGoogle Scholar
  31. 31.
    Bartoccioni E, Evoli A, Casali C et al (1986) Neonatal myasthenia gravis: clinical and immunological study of seven mothers and their newborn infants. J Neuroimmunol 12:155–161PubMedCrossRefGoogle Scholar
  32. 32.
    Gardnerova M, Eymard B, Morel E et al (1997) The fetal/adult acetylcholine receptor antibody ratio in mothers with myasthenia gravis as a marker for transfer of the disease to the newborn. Neurology 48:50–54PubMedCrossRefGoogle Scholar
  33. 33.
    Tzartos SJ, Efthimiadis E, Morel B et al (1990) Neonatal myasthenia gravis: antigenic specificities of antibodies in sera from mothers and their infants. Clin Exp Immunol 80:376PubMedCrossRefGoogle Scholar
  34. 34.
    Brenner T, Beyth Y, Abramsky O (1980) Inhibitory effect of a-fetoprotein on the binding of myasthenia gravis antibody to acetylcholine receptor. Proc Nat Acad Sci USA 77:3635–3639PubMedCrossRefGoogle Scholar
  35. 35.
    Jacobson L, Polizzi A, Morriss-Kay G, Vincent A (1999) Plasma from human mothers of fetuses with severe arthrogriposis multiplex congenita causes deformities in mice. J Clin Invest 103:1031–1038PubMedCrossRefGoogle Scholar
  36. 36.
    Barnes RJ, Kanabar DJ, Brueton L et al (1995) Recurrent congenital arthrogriposis leading to a diagnosis of myasthenia gravis in an initially symptomatic mother. Neuromusc Disord 5:59–65PubMedCrossRefGoogle Scholar
  37. 37.
    Riemersma S, Vincent A, Beeson D et al (1996) Association of arthrogryposis multiplex congenita with maternal antibodies inhibiting fetal acetylcholine receptor function. J Clin Invest 98:2358–2363PubMedCrossRefGoogle Scholar
  38. 38.
    Cooker J, Thompson RM (1966) Multiple smooth muscle hypertrophies in a new born infant. Arch Dis Child 41:514–518CrossRefGoogle Scholar
  39. 39.
    Hangen G, Fauchald P, Sodal G et al (1994) Pregnancy outcome in renal allograft recipients in Norway. Acta Obstet Gynecol Scand 73:541–546CrossRefGoogle Scholar
  40. 40.
    Hangen G, Fauchald P, Sodal G et al (1991) Pregnancy outcome in renal allograft recipients: influence of cyclosporin A. Eur J Obstet Gynecol Reprod Biol 39:25–29CrossRefGoogle Scholar
  41. 41.
    Scantlebury V, Gordon R, Tzakis A et al (1990) Childbearing after liver transplantation. Transplantation 49:317–321PubMedCrossRefGoogle Scholar
  42. 42.
    Wagoner LE, Taylor DO, Olsen SL et al (1993) Immunosuppressive therapy, management, and outcome of heart transplant recipients during pregnancy. J Heart Lung Transplant 12:993–999PubMedGoogle Scholar
  43. 43.
    Jain A, Venkataramanan R, Fung JJ et al (1997) Pregnancy after liver transplantation under tacrolimus. Transplantation 64:559–565PubMedCrossRefGoogle Scholar
  44. 44.
    Ramsey-Goldman R, Mientus JM, Kutzer JE et al (1993) Pregnancy outcome in women with systemic lupus erythematosus treated with immunosuppressive drugs. J Rheumatol 20:1152–1157PubMedGoogle Scholar
  45. 45.
    Martinez-Rueda JO, Arce-Salinas CA, Kraus A et al (1996) Factors associated with fetal losses in severe systemic lupus erythematosus. Lupus 5:113–119.PubMedCrossRefGoogle Scholar
  46. 46.
    Alstead EM, Ritchie JK, Lennard-Jones JE et al (1990) Safety of azathioprine in pregnancy in inflammatory bowel disease. Gastroenterology 99:443–446PubMedGoogle Scholar
  47. 47.
    Buckley LM, Bullaboy CA, Leichtman L, Marquez M (1997) Multiple congenital anomalies associated with weekly low-dose methotrexate treatment of the mother. Arthritis Rheum 40:971–973PubMedCrossRefGoogle Scholar
  48. 48.
    Fraser FC, Sajoo A (1995) Teratogenic potential of corticosteroids in humans. Teratology 51:45–46PubMedCrossRefGoogle Scholar
  49. 49.
    Gaudier FL, Santiago-Delin E, Rivera J, Gonzales Z (1988) Pregnancy after renal transplantation. Surg Gynecol Obstet 167:533–543PubMedGoogle Scholar
  50. 50.
    Schmidt PL, Sims ME, Strassner HT et al (1984) Effect of antepartum glucocorticoid administration upon neonatal respiratory distress syndrome and perinatal infection. Am J Obstet Gynecol 178:178–186Google Scholar
  51. 51.
    Tuchmann-Duplessis H, Mercier-Parot L (1996) Production in rabbits of malformations of the limbs by azathioprine and 6-mercaptopurine. CR Soc Biol 166:501–506Google Scholar
  52. 52.
    Ramsey-Goldmman R, Schilling E (1997) Immunosuppressive drug use in pregnancy. Rheum Dis Clin North Am 23:149–167CrossRefGoogle Scholar
  53. 53.
    Casele HL, Laifer SA (1998) Association of pregnancy complications and choice of immunosuppressant in liver transplant patients. Transplantation 27:581–583CrossRefGoogle Scholar
  54. 54.
    Present DH, Meltzer SJ, Krumholz MP et al (1989) 6-mercaptopurine in the managment of inflammatory bowel disease: short and long term toxicity. Ann Intern Med 111:641–649PubMedGoogle Scholar
  55. 55.
    Watson WJ, Katz VL, Bowes WA (1984) Plasmapheresis during pregnancy. Obstet Gynecol 76:451–457Google Scholar
  56. 56.
    Kaaja R, Julkunen A, Ammala P et al (1993) Intravenous immunoglobulin treatment of pregnant patients with recurrent pregnancy losses associated with antiphospholipid antibodies. Acta Obstet Gynecol Scand 72:63–66PubMedCrossRefGoogle Scholar
  57. 57.
    Brenner T, Shahin R, Steiner I, Abramsky O (1992) Presence of anti-acetylcholine receptor antibodies in human milk: possible correlation with neonatal myasthenia gravis. Autoimmunity 12:315–316PubMedCrossRefGoogle Scholar
  58. 58.
    Osserman KE, Kornfild P, Cohen E et al (1958) Studies in myasthenia gravis. AMA Arch Intern Med 102:72–81PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2002

Authors and Affiliations

  • A. P. Batocchi
    • 1
  1. 1.Institute of NeurologyCatholic UniversityRomeItaly

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