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MuSK myasthenia gravis and pregnancy.
Santos E1, Braga A2, Gabriel D3, Duarte S3, Martins da Silva A4, Matos I5, Freijo M5, Martins J6, Silveira F7, Nadais G7, Sousa F8, Fraga C9, Santos Silva R10, Lopes C11, Gonçalves G12, Pinto C2, Sousa Braga J2, Leite MI13.
Neuromuscul Disord. 2017 Nov 28. pii: S0960-8966(17)31225-7. doi: 10.1016/j.nmd.2017.11.014.
Abstract
Muscle specific kinase (MuSK) myasthenia gravis (MG, MuSK-MG) is a rare subgroup of MG affecting mainly women during childbearing years.
We investigated the influence of pregnancy in the course of MuSK-MG and pregnancy outcomes in females with MuSK-MG.
A multicentre cohort of 17 women with MuSK-MG was studied retrospectively; 13 of them with ≥1 pregnancy. MuSK-MG onset age was 35,4 years; 23,0% had other autoimmune disorder; 46,2% were treatment refractory.
Thirteen women experienced 27 pregnancies, either after MG onset (group I) (n = 4; maternal age at conception = 29.8 years) or before MG onset (group II) (n = 23; maternal age at conception = 26.2 years).
In group I pregnancy occurred in average 9.8 years after the MG onset; it occurred in average 17.0 years before MG in group II.
In group I, all were on steroids at time of conception, one on azathioprine and another receiving IVIG regularly.
There were mild exacerbations that responded to treatment adjustments.
There were no relapses in the 12 months following the delivery.
There was no pre-eclampsia, birth defects or stillbirths in either group; 3 miscarriages in group II.
One case of neonatal MG was recorded.
In this small series, pregnancy did not seem to precipitate MuSK-MG or to have a major influence in the MuSK-MG course, and there was no apparent negative impact in pregnancy outcomes in those where pregnancy followed the MG onset.
The weight was lower in the newborn of the group I mothers, although none had low birth weight.
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