Maternal and Neonatal Outcomes Among Pregnant Women With Myasthenia Gravis [22O

Abstract

INTRODUCTION: 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 Healthcare Cost and Utilization Project Nationwide Inpatient Sample from 1999 to 2015, we conducted a population-based retrospective cohort study consisting of women who delivered during that period. Multivariate logistic regression was used to compare maternal and neonatal outcomes among pregnancies in women with and without MG, while adjusting for baseline maternal characteristics. IRB approval was not required for this study. RESULTS: During the 17-year study period, 1087 deliveries were to women with MG. Women with MG were more likely to be older, Caucasian, obese, have Medicare insurance and be discharged from an urban teaching hospital. Women with MG were also more likely to be smokers, have chronic hypertension, pre-gestational diabetes, hypothyroidism and display chronic steroid use. Women with MG were at greater risk for acute respiratory failure (OR 15.7, 95% CI 10.6–23.3) and increased length of hospital stay (OR 2.6, 95% CI 2.0–3.3). No significant difference was observed in the risk of preterm premature rupture of membranes, cesarean section or instrumental vaginal delivery. Neonates of women with MG were also more likely to be premature (OR 1.4, 95% CI 1.1–1.6). CONCLUSION: MG in pregnancy is a high-risk pregnancy condition associated with adverse maternal and newborn outcomes. Management in a tertiary care center with obstetrical, neurological and anesthesia collaboration is recommended.