Study has ‘wonderful news’ for MG patients considering pregnancy
Pregnancy does not increase risk of hospitalization, researchers find
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- Pregnancy does not increase hospitalization risk for MG patients.
- Postpartum, prolonged hospitalizations for flares are higher for a minority.
- Careful monitoring during and after pregnancy is crucial.
Being pregnant does not increase the risk of hospitalizations for women with myasthenia gravis (MG), a study in Sweden found.
Findings also indicate that the risk of MG-related hospitalization is not significantly increased after birth. However, for the minority of patients who are hospitalized during this period, these hospitalizations tend to be longer than hospitalizations before getting pregnant.
The study, “Risk of Myasthenia Gravis Exacerbation During Pregnancy and Postpartum A Nationwide Cohort Study,” was published in Neurology.
“This is wonderful news for women with myasthenia gravis, as previous small studies had conflicting results and many women choose not to have children due to fear that the disease will get worse during or after pregnancy,” Anna Rostedt Punga, MD, PhD, the study’s senior author and a professor at Uppsala University in Sweden, said in a press release from the American Academy of Neurology, the publisher of Neurology. “It’s reassuring to see that pregnancy did not lead to an increase in serious flare-ups and, for the majority of women, that was also true in the months after birth.”
MG symptoms include muscle weakness and fatigue. The disease is often marked by exacerbations or flares, when symptoms suddenly worsen. These can lead to hospitalization.
Women disproportionately affected
Like most autoimmune diseases, MG disproportionately affects women, and it often manifests in early adulthood. Studies have shown that many women with MG are hesitant about pursuing pregnancy, with the fear of MG flares rated as a top reason for choosing not to get pregnant.
“These concerns highlight the broader impact of MG, not only on physical health but also on reproductive decision making and quality of life,” the researchers wrote.
But there’s not much published data on whether MG flares are more common during pregnancy. To address this, the scientists analyzed decades’ worth of data from a national registry in Sweden.
They looked at data from 112 women (median age 30) who had a total of 176 pregnancies. At the time of pregnancy, they had been living with MG for a median of eight years.
As a proxy for MG flares, the researchers analyzed rates and duration of hospital admissions for MG as the main diagnosis during and after pregnancy, comparing them to those in the year before pregnancy. Statistical analyses showed that hospitalization rates during pregnancy were not significantly different from those in the year before pregnancy.
The risk of prolonged hospitalizations was also not significantly different between the pre-pregnancy and pregnancy periods.
In the first year after giving birth (postpartum), overall hospitalization rates were not significantly different from those before pregnancy. Specifically, 10.8% of all pregnancies required at least one hospital admission in the first year after birth, compared with 6.8% in the year before pregnancy.
However, the postpartum period was associated with a significantly higher risk of prolonged hospitalization, by about five times, in both the first three months after birth and the first year postpartum. These data “indicate that postpartum exacerbations, although infrequent, can be more severe or prolonged when they do occur,” the researchers wrote.
Of the 16 women who were hospitalized in the postpartum period, more than half (56%) went on to get pregnant again, but without requiring any hospitalization. Rostedt Punga said these data show that “disease exacerbations are not a foregone conclusion.”
The risk of prolonged MG hospitalizations was generally, but not significantly, lower in the year before pregnancy than in other time periods studied. This suggests that women with MG “were more likely to conceive during periods of relative clinical stability,” the researchers wrote.
The study did have limitations, the researchers said. They noted that “reliance on hospital admissions as a proxy for MG exacerbations risks capturing only the more severe exacerbations.”
Still, the team concluded that their data underscore the importance of careful monitoring during and especially after pregnancy for women with MG. “The postpartum period was linked to more severe or prolonged exacerbations in a minority of women, highlighting the importance of close monitoring after delivery,” they wrote.
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