Women with MG have higher risk of complications during pregnancy
Study: More than half discontinued treatment during perinatal period
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- Pregnant women with myasthenia gravis face higher risks of preeclampsia and C-sections.
- Their infants are more likely to be born prematurely and small for gestational age.
- Many women discontinue MG treatment during pregnancy; safer options and clearer guidelines are needed.
Women with myasthenia gravis (MG) have a higher risk of pregnancy complications, particularly preeclampsia, and their babies are more likely to be born prematurely and small for their gestational age, according to a study in the U.S.
Preeclampsia is a serious pregnancy complication marked by new-onset high blood pressure and the presence of protein in the urine, which is a sign of kidney problems.
In addition, more than half of pregnant women with MG discontinued treatment during the perinatal period, defined as the six months before and after pregnancy, and those who received treatment were usually exposed to only one treatment type, data showed.
The findings indicate that “MG was associated with a greater prevalence of certain perinatal outcomes, occurring in both mother and infant,” researchers wrote. “Though most patients did not receive treatment in pregnancy[,] those who did showed variation over time, suggesting a potential need for this population.”
The study, “Characterizing Perinatal Treatment Patterns and Outcomes in Myasthenia Gravis,” was published in Muscle & Nerve by a team of researchers in the U.S.
Pregnancy can exacerbate MG symptoms
MG is typically caused by self-reactive antibodies that attack proteins involved in nerve-muscle communication, affecting the muscles that control voluntary movements.
Pregnancy can exacerbate MG symptoms, which may require specific treatment modifications. There has also been conflicting evidence as to whether MG is linked to an increased risk of pregnancy complications.
“Several of these … studies had smaller sample sizes and only evaluated a narrow suite of perinatal outcomes,” the researchers wrote. “A more comprehensive examination of perinatal and infant outcomes in MG with a large sample size is needed to further elucidate the burden in this population. In addition, United States-based evidence is lacking in MG.”
To learn more, the team retrospectively analyzed data from pregnant women with MG, ages 18 years to 49 years, in U.S. health insurance claims databases, including commercial health insurance.
A total of 900 pregnancies were registered in 694 women with MG, of which 675 (75%) ended in a live birth and 184 (20.4%) in a spontaneous abortion. Rates of live birth and spontaneous abortion were comparable to those observed in the age-adjusted general population, comprised of more than 5,000,000 pregnant women (72.6% and 22.2%, respectively).
Pregnant women with MG more likely to have preeclampsia
Pregnant women with MG were significantly more likely to have preeclampsia (10.7% vs. 7.1%) and deliver their babies by cesarean section (42.9% vs. 36.7%). Babies in the MG group were significantly more likely to be born before 37 weeks of gestation ( 18% vs. 9.9%), defined as preterm birth, and to be small for their gestational age (4.3% vs. 1.7%).
Among 647 pregnancies with continuous enrollment from before pregnancy through after delivery (perinatal period), more than half of the women were not treated for MG during the perinatal period.
Among women who received treatment during the perinatal period, most were exposed to just one class of MG treatment, most commonly acetylcholinesterase inhibitors and corticosteroids. All treatment types were reduced to a minimum during pregnancy, particularly in the first trimester.
Almost half of the women (47%) showed some change in treatment between preconception and pregnancy or between early and late pregnancy. Particularly, 21.8% and 33.1% of those taking acetylcholinesterase inhibitors or corticosteroids in pregnancy, respectively, had not been taking these before pregnancy.
According to the researchers, this study “underscores the complexity in treating MG in pregnancy and … [suggests] a need for safe treatments in pregnancy and robust data showing their benefit–risk profile as well as improved treatment guidelines in this specific population. Finally, further research is needed to understand treatment[-] and non-treatment-related predictors of pregnancy outcomes in MG.”
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