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Maternal and neonatal outcomes among pregnant women with myasthenia gravis

  • Laura Nicholls-Dempsey , Nicholas Czuzoj-Shulman and Haim Arie Abenhaim EMAIL logo
Published/Copyright: August 3, 2020
Journal of Perinatal Medicine
From the journal Journal of Perinatal Medicine Volume 48 Issue 8

Abstract

Objectives

Myasthenia gravis (MG) is an autoimmune disease affecting the neuromuscular junction marked by weakness and fatiguability of skeletal muscle. MG has an unpredictable course in pregnancy. Our purpose was to evaluate the effect of MG on maternal and neonatal outcomes.

Methods

Using the United States’ Healthcare Cost and Utilization Project Nationwide Inpatient Sample from 2005 to 2015, we conducted a retrospective cohort study consisting of women who delivered during that period. Multivariate logistic regression models, adjusted for baseline maternal demographics and comorbidities, were used to compare maternal and neonatal outcomes among pregnancies in women with and without MG.

Results

During the study period, 974 deliveries were to women diagnosed with MG. Women with MG were more likely to be older, African American, obese, have Medicare insurance and be discharged from an urban teaching hospital. Women with MG were also more likely to have chronic hypertension, pre-gestational diabetes, hypothyroidism, and chronic steroid use. Women with MG were at greater risk for acute respiratory failure (OR 13.7, 95% CI 8.9–21.2) and increased length of hospital stay (OR 2.5, 95% CI 1.9–3.3). No significant difference was observed in the risk of preterm premature rupture of membranes, caesarean section or instrumental vaginal delivery. Neonates of women with MG were more likely to be premature (OR 1.4, 95% CI 1.2–1.8).

Conclusions

MG in pregnancy is a high-risk condition associated with greater risk of maternal respiratory failure and preterm birth. Management in a tertiary care center with obstetrical, neurological, anesthesia and neonatology collaboration is recommended.

Keywords: autoimmune diseases; myasthenia gravis; neonatal; pregnancy
Corresponding author: Haim Arie Abenhaim, MD, MPH, FRCSC, Jewish General Hospital, Obstetrics and Gynecology, McGill University, Pav H, Room 325, 5790 Cote-Des-Neiges Road, Montreal, QC, H3S 1Y9, Canada; Center for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, QC, Canada. Phone: +1 514 340 8222 x 24187, Fax: +1 514 340 7941, E-mail:

  1. Research funding: None declared.

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.

  4. Ethical approval: The local Institutional Review Board deemed the study exempt from review.

References

1. Djelmis, J, Sostarko, M, Mayer, D, Ivanisevic, M. Myasthenia gravis in pregnancy: report on 69 cases. Eur J Obstet Gynecol Reprod Biol 2002;104:21–5, https://doi.org/10.1016/s0301-2115(02)00051-9.Search in Google Scholar PubMed

2. Ciafaloni, E, Massey, JM. Myasthenia gravis and pregnancy. Neurol Clin 2004;22:771–82, https://doi.org/10.1016/j.ncl.2004.06.003.Search in Google Scholar PubMed

3. Tellez-Zenteno, JF, Hernandez-Ronquillo, L, Salinas, V, Estanol, B, da Silva, O. Myasthenia gravis and pregnancy: clinical implications and neonatal outcome. BMC Muscoskel Disord 2004;5:42, https://doi.org/10.1186/1471-2474-5-42.Search in Google Scholar PubMed PubMed Central

4. Varner, M. Myasthenia gravis and pregnancy. Clin Obstet Gynecol 2013;56:372–81, https://doi.org/10.1097/grf.0b013e31828e92c0.Search in Google Scholar

5. Tanacan, A, Fadiloglu, E, Ozten, G, Gunes, AC, Orgul, G, Beksac, MS. Myasthenia gravis and pregnancy: retrospective evaluation of 27 pregnancies in a tertiary center and comparison with previous studies. Ir J Med Sci 2019;188:1261–67, https://doi.org/10.1007/s11845-019-02029-0.Search in Google Scholar PubMed

6. Ferrero, S, Pretta, S, Nicoletti, A, Petrera, P, Ragni, N. Myasthenia gravis: management issues during pregnancy. Eur J Obstet Gynecol Reprod Biol 2005;121:129–38, https://doi.org/10.1016/j.ejogrb.2005.01.002.Search in Google Scholar PubMed

7. Braga, AC, Pinto, C, Santos, E, Braga, J. Myasthenia gravis in pregnancy: experience of a Portuguese center. Muscle Nerve 2016;54:715–20, https://doi.org/10.1002/mus.25095.Search in Google Scholar PubMed

8. Ducci, RD, Lorenzoni, PJ, Kay, CS, Werneck, LC, Scola, RH. Clinical follow-up of pregnancy in myasthenia gravis patients. Neuromuscul Disord 2017;27:352–57, https://doi.org/10.1016/j.nmd.2017.01.021.Search in Google Scholar PubMed

9. Giwa-Osagie, OF, Newton, JR, Larcher, V. Obstetric performance of patients with myasthenia gravis. Int J Gynecol Obstet 1981;19:267–70, https://doi.org/10.1016/0020-7292(81)90073-4.Search in Google Scholar PubMed

10. Mitchell, PJ, Bebbington, M. Myasthenia gravis in pregnancy. Obstet Gynecol 1992;80:178–81.10.1016/0020-7292(93)90171-RSearch in Google Scholar

11. Tsurane, K, Tanabe, S, Miyasaka, N, Matsuda, M, Takahara, M, Ida, T, et al. Management of labor and delivery in myasthenia gravis: a new protocol. J Obstet Gynaecol Res 2019;45:974–80, https://doi.org/10.1111/jog.13922.Search in Google Scholar PubMed

12. Batocchi, AP, Majolini, L, Evoli, A, Lino, MM, Minisci, C, Tonali, P. Course and treatment of myasthenia gravis during pregnancy. Neurology 1999;52:447–52, https://doi.org/10.1212/wnl.52.3.447.Search in Google Scholar PubMed

13. Hoff, JM, Daltveit, AK, Gilhus, NE. Myasthenia gravis: consequences for pregnancy, delivery, and the newborn. Neurology 2003;61:1362–6, https://doi.org/10.1212/01.wnl.0000082725.21444.ec.Search in Google Scholar PubMed

14. Wen, JC, Liu, TC, Chen, YH, Chen, SF, Lin, HC, Tsai, WC. No increased risk of adverse pregnancy outcomes for women with myasthenia gravis: a nationwide population-based study. Eur J Neurol 2009;16:889–94, https://doi.org/10.1111/j.1468-1331.2009.02689.x.Search in Google Scholar PubMed

15. Bansal, R, Goyal, MK, Modi, M. Management of myasthenia gravis during pregnancy. Indian J Pharmacol 2018;50:302–08, https://doi.org/10.4103/ijp.ijp_692_17.Search in Google Scholar

16. Waters, J. Management of myasthenia gravis in pregnancy. Neurol Clin 2019;37:113–20, https://doi.org/10.1016/j.ncl.2018.09.003.Search in Google Scholar PubMed

17. Ferrero, S, Esposito, F, Biamonti, M, Bentivoglio, G, Ragni, N. Myasthenia gravis during pregnancy. Expert Rev Neurother 2008;8:979–88, https://doi.org/10.1586/14737175.8.6.979.Search in Google Scholar PubMed

18. Hassan, A, Yasawy, ZM. Mysathenia gravis clinical management issues before, during and after pregnancy. Sultan Qaboos Univer Med J 2017;17:e259–67, https://doi.org/10.18295/squmj.2017.17.03.002.Search in Google Scholar PubMed PubMed Central

Received: 2020-04-14
Accepted: 2020-07-02
Published Online: 2020-08-03
Published in Print: 2020-10-25

© 2020 Walter de Gruyter GmbH, Berlin/Boston

Articles in the same Issue

  1. Frontmatter
  2. Review
  3. What is known and what remains unresolved regarding gestational diabetes mellitus (GDM)
  4. Corner of Academy
  5. Stillbirth and subsequent pregnancy outcome – a cohort from a large tertiary referral hospital
  6. Postmortem examination protocol and systematic re-evaluation reduce the proportion of unexplained stillbirths
  7. Original Articles – Obstetrics
  8. The first-trimester serum decorin levels as a potential predictor of preeclampsia
  9. Increased of the carotid intima media thickness in preeclampsia
  10. Maternal and neonatal outcomes among pregnant women with myasthenia gravis
  11. The effect of an oxytocin washout period on blood loss at cesarean delivery
  12. Clinical analysis of the preoperative condition and operative prognosis of post-cesarean section scar diverticulum: a case series
  13. Prolonged interpregnancy interval: how does it impact the length of second stage of labor?
  14. Furcate insertion of the umbilical cord: pathological and clinical characteristics in 132 cases
  15. Assisted reproductive technologies (ART) and placental abnormalities
  16. Pregnancy, oral health and dental education: an overview on the northeast of Italy
  17. Impact of an on-site perinatal mood disorders clinic in the diagnosis and management of perinatal mood disorders
  18. Original Articles – Newborn
  19. C-reactive protein as a predictor of meningitis in early onset neonatal sepsis: a single unit experience
  20. Short Communication
  21. Pharmaco-vigilance of oral MethylErgometrine prescriptions for delayed and secondary postpartum haemorrhage
https://doi.org/10.1515/jpm-2020-0163
Keywords for this article
autoimmune diseases; myasthenia gravis; neonatal; pregnancy

Articles in the same Issue

  1. Frontmatter
  2. Review
  3. What is known and what remains unresolved regarding gestational diabetes mellitus (GDM)
  4. Corner of Academy
  5. Stillbirth and subsequent pregnancy outcome – a cohort from a large tertiary referral hospital
  6. Postmortem examination protocol and systematic re-evaluation reduce the proportion of unexplained stillbirths
  7. Original Articles – Obstetrics
  8. The first-trimester serum decorin levels as a potential predictor of preeclampsia
  9. Increased of the carotid intima media thickness in preeclampsia
  10. Maternal and neonatal outcomes among pregnant women with myasthenia gravis
  11. The effect of an oxytocin washout period on blood loss at cesarean delivery
  12. Clinical analysis of the preoperative condition and operative prognosis of post-cesarean section scar diverticulum: a case series
  13. Prolonged interpregnancy interval: how does it impact the length of second stage of labor?
  14. Furcate insertion of the umbilical cord: pathological and clinical characteristics in 132 cases
  15. Assisted reproductive technologies (ART) and placental abnormalities
  16. Pregnancy, oral health and dental education: an overview on the northeast of Italy
  17. Impact of an on-site perinatal mood disorders clinic in the diagnosis and management of perinatal mood disorders
  18. Original Articles – Newborn
  19. C-reactive protein as a predictor of meningitis in early onset neonatal sepsis: a single unit experience
  20. Short Communication
  21. Pharmaco-vigilance of oral MethylErgometrine prescriptions for delayed and secondary postpartum haemorrhage
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