Abstract
Myasthenia gravis is a neuro-immunological disease due to the blockage of motor plate post-synaptic receptors by antiacetylcholine receptors antibodies, causing excessive fatigability of skeletal striated muscles. Thus, vital prognosis is engaged by swallowing disorders and respiratory distress related to pharyngeal striated and intercostal muscles damage. Myasthenia evolves by flare-ups, with two peaks of prevalence: first one, between 20 and 30 years-old with femal predominance. Then after 40 years-old, sex ratio evens out. Therefore, association of myasthenia and pregnancy is not exceptional, hence the interest in knowing particularities of these pregnancies, to ensure optimal monitoring for both mother and child. Indeed, mother’s risk is myasthenia decompensation, while child’s risk is neonatal myasthenia gravis. We report three myasthenia and pregnancy cases, from prenatal period to pueripartum, then we discuss in literature light, myasthenia gravis bidirectional influence on pregnancy, as well as impact of anti-myasthenic treatments on pregnancy.
Highlights
Myasthenia gravis is a chronic autoimmune neurological disease, linked to a blockage of transmission at neuromuscular motor plate post-synaptic receptors by antiacetylcholine nicotinic receptors antibodies, which are detectable in approximately 80% of generalized myasthenias
Breastfeeding was allowed subject to muscarinic hyperstimulation signs appearance, an infection check-up consisting on hemogram, C-reactive protein and trans-fontanel ultrasound scan were recommended to eliminate maternal-fetal infection in membranes premature rupture (MPR) context, came back negative
Myasthenia gravis is manifested by strial musculature abnormal fluctuating fatigability, leading to ptosis, diplopia, chewing, swallowing and speaking difficulties, and scapular-pelvic belts weakness
Summary
Myasthenia gravis is a chronic autoimmune neurological disease, linked to a blockage of transmission at neuromuscular motor plate post-synaptic receptors by antiacetylcholine nicotinic receptors antibodies, which are detectable in approximately 80% of generalized myasthenias. Breastfeeding was allowed subject to muscarinic hyperstimulation signs appearance, an infection check-up consisting on hemogram, C-reactive protein and trans-fontanel ultrasound scan were recommended to eliminate maternal-fetal infection in MPR context, came back negative She did not show signs of decompensation, newborn did not show objective signs of neonatal myasthenia gravis. Mrs O.E. is 35 years-old, 3 gestities, 2 parities (vaginal delivery), diagnosed with myasthenia gravis since 13 years, undergoing treatment: pyridostigmine (Mestinon 60 mg) 6 tablets/day and azathioprine (Imurel 50 mg) 3 tablets/day. She did not benefit from a thymectomy. Patient did not show signs of myasthenic decompensation in puerperium
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