Myasthenia gravis ‘unpredictable’ during pregnancy, case study shows

Despite complications, mother and baby reported in good health after birth

Marisa Wexler, MS avatar

by Marisa Wexler, MS |

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A pregnant woman is seen cradling her belly with both hands while walking.

The case of a pregnant woman with myasthenia gravis (MG) who saw her disease worsen and who developed hydramnios — an abnormal buildup of fluid around the fetus during pregnancy — was described in a new report that researchers say highlights how variable the condition can be.

Despite the complications, with close monitoring and treatment, both mother and baby left the hospital in good health a few days after birth.

“The course of MG during pregnancy is unpredictable,” the authors wrote, adding that “patients with MG require multidisciplinary management to ensure optimal therapy.”

Her case was described in the study “Myasthenia gravis and pregnancy: Lessons learned from a complex a case report,” published in the journal Sage Open Medical Case Reports.

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Study Estimates Risks of MG-related Problems During Pregnancy at 34%

Woman with myasthenia gravis monitored closely during 2nd pregnancy

The relationship between pregnancy and myasthenia gravis, or MG for short, is complex. While the hormonal shifts that occur during pregnancy can affect the course and severity of MG, at the same time, the disease also can influence pregnancy progression and the wellbeing of the developing fetus.

In this report, a team of scientists in Morocco described the case of a 28-year-old woman with MG who saw her disease worsen during pregnancy.

The woman had been diagnosed with MG several years earlier, shortly after she became pregnant for the first time. She didn’t have any major problems during her first pregnancy, but while pushing during labor she had started to experience difficulty breathing. This prompted doctors to order lab tests that ultimately revealed the presence of antibodies against the acetylcholine receptor (AChR) — the most common ones known to cause MG.

After being diagnosed, she started treatment with the muscle-strengthening medication Mestinon (pyridostigmine bromide), as well as immunosuppressant and anti-inflammatory medicines, namely azathioprine and prednisone. She also underwent a thymectomy, or a surgery to remove the thymus gland.

A few years later, she decided she wanted to have another child. After consultation with her doctors, she stopped taking Mestinon, and a few months later, she became pregnant for a second time. Given the complexity of MG during pregnancy, she was under close monitoring from an obstetric team and a neurologist during while pregnant.

The pregnancy itself was uneventful until the 33rd week (of the typical 40 weeks), at which point a routine ultrasound revealed an abnormal buildup of fluid around the fetus, known as hydramnios. The woman was hospitalized for more monitoring and tests, which were mostly normal, but a few days later she started developing unusual muscle fatigue.

A neurological examination then revealed weakness around the hips and legs, and the woman was diagnosed with myasthenic decompensation — a worsening of MG. She was restarted on Mestinon, which improved her muscle strength within a week.

Less than a month later, in the 36th week of pregnancy, she went into labor and gave birth. The newborn had some mild muscle weakness and difficulty breathing at first — suggestive of mild transient neonatal MG, in which the mother’s autoantibodies can be transferred to her unborn child during pregnancy — but recovered quickly with supportive care.

Both mother and newborn were discharged from the hospital within a week, and are reported to be in good health, according to the researchers.

The team concluded that “MG does not significantly increase other complications of pregnancy.”