[Pubmed] Treatment considerations in myasthenia gravis for the pregnant patient

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Expert Rev Neurother. 2023 Feb 14. doi: 10.1080/14737175.2023.2178302. Online ahead of print.

ABSTRACT

INTRODUCTION: Myasthenia gravis (MG) is an autoimmune disease where muscle antibodies form against the acetylcholine receptor (AChR), MuSK, or LRP4 at the neuromuscular junction leading to weakness. Patients worry about the consequences for pregnancy, giving birth, nursing, and child outcome.

AREAS COVERED: This review lists the pharmacological treatments for MG in the reproductive age and gives recommendations. Consequences for pregnancy, giving birth, breastfeeding, and child outcome are discussed.

EXPERT OPINION: Pyridostigmine, corticosteroids in low and moderate doses, and azathioprine are regarded as safe during pregnancy and should be continued. Mycophenolate mofetil, methotrexate, and cyclophosphamide should not be used in reproductive age. Rituximab should not be given during pregnancy. Other monoclonal IgG antibodies such as eculizumab and efgartigimod should be given only when regarded strictly necessary to avoid long-term and severe incapacity. Intravenous and subcutaneous immunoglobulin and plasma exchange are safe treatments during pregnancy and are recommended for exacerbations with moderate or severe generalized weakness. Most MG women have spontaneous vaginal deliveries. Indications for Caesarean section are obstetrical and similar to non-MG women. Neonatal myasthenia manifests as a transient weakness caused by the mother's IgG muscle antibodies and affects 10% of babies. MG women should be supported in their wish to have children.

PMID:36786092 | DOI:10.1080/14737175.2023.2178302


Source: https://pubmed.ncbi.nlm.nih.gov/3678609 ... t6+86293ac