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Management of myasthenia gravis in pregnancy
Yuko Shimizu* andKazuo Kitagawa
Version of Record online: 10 MAY 2016- DOI: 10.1111/cen3.12305
To a neurologist, pregnancy and delivery are major issues for patients with neuroimmunological diseases, including myasthenia gravis (MG).
MG is an autoimmune disease caused by antibodies against the nicotinic acetylcholine receptor or other postsynaptic antigens, such as muscle-specific kinase or low-density lipoprotein receptor-related protein 4.
In Japan, a nationwide survey in 2006 showed that 15 100 people, or 11.8 per 100 000 persons, had been diagnosed with MG. In women with MG who became pregnant, the disease symptoms worsened for 41%, whereas 30% showed no change, and 29% had remission of symptoms. Exacerbations occur in the first trimester and in the first 3 months postpartum.
It is also important to watch for transient neonatal MG, which occurs in 10–30% of infants delivered by mothers with MG. It is critical to carefully monitor antimuscle-specific kinase antibody-positive patients with MG because of their greater risk for bulbar palsy.
The present review discusses the effects of pregnancy on MG and the management of MG in pregnancy.