MYASTHENIA-GRAVIS IN PREGNANCY - UPDATE

Myasthenia gravis (MG) is an autoimmune neuromuscular disorder characterized by the presence of anti-acetylcholine receptor immunoglobulin G antibodies (anti-AChRIgG). This paper contrasts immunologic intervention, particularly long-term glucocorticoid therapy, with standard anticholinesterase therapy for pregnant MG patients. Ten new cases of pregnancy in myasthenic mothers are reported. A survey of the 40 yr anticholinesterase era yielded reports of 292 pregnancies in 202 myasthenia mothers. Instability of MG during pregnancy is highlighted by gestation related exacerbations identified in 55% of cases. The puerperium appears particularly dangerous. Eight of 9 maternal deaths (4.45%) in this series were from myasthenic complications. Prenatal care and labor management are discussed. The adverse effects of fatigue, analgesic and anesthetic agents, and magnesium sulfate are emphasized. Crisis differentiation and management are outlined. Neonatal myasthenic syndromes and their relationship to anti-AChRIgG are presented. Neonatal MG occurred in 20.2% of newborn infants in the review series. Six infants were stillborn (2.1%) and 11 died in the neonatal period (3.8%).