Myasthenia gravis in pregnancy and birth: Identifying risk factors, optimising care

Department of Public Health and Primary Health Care, University of Bergen, Bergen, Hordaland, Norway
European Journal of Neurology (Impact Factor: 4.06). 02/2007; 14(1):38-43. DOI: 10.1111/j.1468-1331.2006.01538.x
Source: PubMed


Women with myasthenia gravis (MG) have increased risk of pregnancy complications and an adverse pregnancy outcome. This study examined risk factors for such complications in order to improve the care for pregnant MG women. Through the Medical Birth Registry of Norway, 73 MG mothers with 135 births were identified. Their obstetrical and clinical records were examined. Data on pregnancy, delivery and the newborn were combined with information on mother's disease. The risk for neonatal MG was halved if the mother was thymectomized (P = 0.03). Children with neonatal MG were more likely to display signs of foetal distress during delivery (P = 0.05). Only in one-third of the pregnancies did the patient see a neurologist during pregnancy. These patients used MG medication more often during pregnancy (P = 0.001), and were more likely to be thymectomized (P = 0.007). They also had a higher rate of elective sections (P = 0.009). Thymectomy may have a protective effect against neonatal MG. Neonatal MG can cause foetal distress during delivery. Most MG women benefit from being examined by a neurologist during pregnancy, to minimize risks and select the best delivery mode in collaboration with obstetricians.

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    • "Increased awareness of the risks associated with pregnancy and delivery should not discourage woman from giving birth. However, management of such patients will need well coordinated interdisciplinary care by obstetricians, neurologists, and paediatricians in order to optimize the treatment and minimize the risks [4]. "
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    ABSTRACT: Neurological conditions during pregnancy can be pregnancy related or can be caused by exacerbation of pre-existing neurological disorders. Knowledge of pre-existing epilepsy or myasthenia gravis in women of childbearing age requires preconception counselling by neurologist and planned pregnancy. Possible adverse effects of medication on the foetus should be balanced with the risk of uncontrolled symptoms. Interdisciplinary management before, during and after pregnancy is recommended. New acute neurological symptoms in pregnant or postpartum women should lead to an urgent neurological review. Patients need a thorough diagnostic evaluation that targets a range of serious pathological conditions that are either unique to (e.g. eclampsia) or arise more frequently (e.g. cerebral venous thrombosis) in this population. Most of these conditions are infrequent and require a specialized and multidisciplinary management. Treatment is challenging due to risks to the unborn child.
    Best practice & research. Clinical obstetrics & gynaecology 08/2013; 27(6). DOI:10.1016/j.bpobgyn.2013.07.007 · 1.92 Impact Factor
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    • "Previous studies validating disease registration in MBRN using hospital records as gold standard did only report sensitivities and can therefore only partly be compared to ours [4,6]. The sensitivity for HG is, however, comparable to the one for rheumatic disease as well as myasthenia gravis [4,6]. "
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    ABSTRACT: Background Valid registration of medical information is essential for the quality of registry-based research. Hyperemesis gravidarum (HG) is characterized by severe nausea and vomiting, weight loss and electrolyte imbalance starting before 22nd gestational week. Given the fact that HG is a generally understudied disease which might have short- and long- term health consequences for mother and child, it is of importance to know whether potential misclassification bias influences the results of future studies. We therefore assessed the validity of the HG-registration in the in Medical Birth Registry of Norway (MBRN) using hospital records. Methods The sample comprised all women registered in MBRN with HG and who delivered at Ullevål and Akershus hospitals in 1.1.-31.3.1970, 1.4.-30.6.1986, 1.7.-30.9.1997 and 1.10.-31.12.2001. A random sample of 10 women per HG case, without HG according to MBRN, but who delivered during the same time periods at the same hospitals was also collected. The final sample included 551 women. Sensitivity, specificity, positive and negative predictive values (PPV and NPV) were estimated using strict and less strict diagnostic criteria of HG, indicating severe and mild HG, respectively. Hospital journals were used as gold standard. Results Using less strict diagnostic criteria of HG, sensitivity, specificity, PPV and NPV were 83.9% (95% CI: 67.4-92.9), 96.0% (95% CI: 93.9-97.3), 55.3% (95% CI: 41.2-68.6) and 99.0% (95% CI: 97.7-99.6), respectively. For strict diagnostic criteria, being hospitalised due to HG the corresponding values were 64% (95% CI: 38.8-87.2), 92% (95% CI: 90.2-94.6), 18.6% (95% CI: 10.2-31.9) and 99.0% (95% CI: 97.7-99.6). Conclusions The results from our study are comparable to previous research on disease registration in MBRN, and show that MBRN can be considered valid for mild HG but not for severe HG.
    BMC Pregnancy and Childbirth 10/2012; 12(1):115. DOI:10.1186/1471-2393-12-115 · 2.19 Impact Factor
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    • "Lactation is recommended by most neurologists irrespective of mother's immunosuppressive MG drug treatment. Previous thymectomy does not influence pregnancy and giving birth negatively and could have a protective effect on neonatal MG [8]. Father's MG is not known to have any influence on the child, apart from the increased risk for MG and other autoimmune disease due to genetic factors. "
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    ABSTRACT: Patients with autoimmune myasthenia gravis (MG) should be further classified before initiating therapy, as treatment response varies for ocular versus generalised, early onset versus late onset, and acetylcholine receptor antibody positive versus MuSK antibody positive disease. Most patients need immunosuppression in addition to symptomatic therapy. Prednisolone and azathioprine represent first choice drugs, whereas several second choice options are recommended and should be considered. Thymectomy should be undertaken in MG with thymoma and in generalised, early-onset MG. For MG crises and other acute exacerbations, intravenous immunoglobulin (IvIg) and plasma exchange are equally effective and safe treatments. Children and females in child bearing age need special attention regarding potential side effects of immunosuppressive therapy. MG pathogenesis is known in detail, but the immune therapy is still surprisingly unspecific, without a pin-pointed attack on the defined disease-inducing antigen-antibody reaction being available.
    10/2011; 2011(1):847393. DOI:10.4061/2011/847393
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