Fetal Surveillance in Pregnancies with Myasthenia Gravis.

Brîndușa Ana Cimpoca-Raptis,Anca Marina Ciobanu,Nicolae Gica,Dan Mitrea,Anca Maria Panaitescu,Gheorghe Peltecu

doi:10.3390/medicina57111277

Abstract

Myasthenia gravis (MG) is an autoimmune condition, that commonly impacts adult women of reproductive age. Myasthenia gravis in pregnancy is rare, but the incidence is higher in different geographical areas. Pregnancies in mothers with MG can have an unfortunate outcome. Acetylcholine receptor antibodies may pass into the fetal circulation and can affect the fetal neuromuscular junction, generating transient MG or even fetal arthrogryposis. The 2016 and 2021 International Consensus Guidance for Management of Myasthenia Gravis issued by Myasthenia Gravis Foundation of America is lacking in recommendation for fetal surveillance for pregnancies in women with MG. The aim of this paper is to highlight fetal and neonatal complications in mothers with MG and to offer antenatal care insights. Close maternal and pregnancy monitoring can improve pregnancy outcome. Patients with MG should be encouraged to conceive, to avoid triggers for exacerbations of the disease during pregnancy and a multidisciplinary team should be established to ensure the optimal support and therapy.

Highlights

Myasthenia gravis (MG) is an autoimmune condition, that commonly impacts young adult women, but it can occur at any age, including childhood
The diagnosis of MG includes detecting the typical antibodies: acetylcholine receptor (AChR-Abs) or muscle-specific tyrosine kinase (MuSK-Abs), in a small group of MG patients, these antibodies are absent in the presence of suggestive clinical features while antibodies against low-density lipoprotein receptor-related protein 4, agrin, titin or ryanodine receptors may be demonstrated with suitable assays [2]
Vaccination before pregnancy is recommended for all women (Table 1)

Summary

Introduction

Myasthenia gravis (MG) is an autoimmune condition, that commonly impacts young adult women (under 40), but it can occur at any age, including childhood. It is not an inherited disease but may be diagnosed in more than one member of the same family. The diagnosis of MG includes detecting the typical antibodies: acetylcholine receptor (AChR-Abs) or muscle-specific tyrosine kinase (MuSK-Abs), in a small group of MG patients, these antibodies are absent in the presence of suggestive clinical features (double seronegative MG) while antibodies against low-density lipoprotein receptor-related protein 4, agrin, titin or ryanodine receptors may be demonstrated with suitable assays [2]

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