Table 1

Summary of previously published studies of myasthenia in pregnancy

Lead author/dateNumber of patients in studyDrug treatmentCourse during pregnancyCourse after deliveryMode of deliveryTransient neonatal myasthenia gravisOther comments
Plauché (1991)4322 pregnancies in 225 womenNot statedNo change in 31.7% during pregnancy or puerperium, relapse in 41%, remission in 29%29.8% exacerbation with 4% death ratePre-1963 CS 5.6%; post-1963 13.5%. 15.4% forceps.16.1% (14.9% definite)Large review series
Batocchi* (1999)564 pregnancies in 47 womenMajority on PYR, very few on immunosuppression (ST, AZA)17% relapse in patients on no therapy; on therapy 39% improved, 19% relapsed, 42% unchanged.
Combined groups 60% worse first trimester, 10% second, 30% third.
28% worseCS rate 30%, most for obstetric reasons9%42 had thymectomy preconception: hyperplasia in 35, thymoma 4
Djelmis (2002)669 pregnancies in 65 women23% no drug treatment, 43% PYR alone, 33% on ST as well. AZA stopped 6–12 months before conception if planned. Nine patients had plasma exchange.14.5% worse, 22% unchanged, 25% improved.16% worseVaginal in 83%, vacuum extraction in 9% and CS in 17% (all but one for obstetric reasons).30%38.5% had thymectomy prepregnancy
Hoff (2003)7127 births in 79 women (1967–2000)Not recorded prior to 1999, thereafter PYR alone in 54.5%.Not statedNot statedCaesarean rate 17.3%, many elective. Forceps/vacuum in 8.7%5 babies had severe anomalies with TNMG in (a different) 5 (4%).Data from Birth Registry. 35.4% prepregnancy thymectomy
Hoff (2004)849 births in 37 asymptomatic/in remission mothersNot statedNot statedNot statedProtracted labour. CS 14.6%, forceps/vacuum 8.2%Increased perinatal mortality (6.1%)
Hoff (2007)9135 births in 73 mothersMedication in 68% but in only 45% throughout pregnancy: PYR alone apart from one on ST and three crisis management10% worseNot statedProtracted labour 19%19%Risk of TNMG halved if mother had had a thymectomy
Wen (2009)10163 womenNot statedNot statedNot statedCS 44.8% (but 37.4% for all births)No significantly increased risk to baby.Concluded that no significant risk of adverse pregnancy outcome
Almeida (2010)11Anaesthetic management of 17 womenNot stated4 worse, 8 no change, 3 first presentationNot statedCS in 5 (of 8 stable) womenNone reported
  • *Prospective study.

  • AZA, azathioprine; CS, caesarean section; PYR, pyridostigmine; ST, corticosteroids; TNMG, transient neonatal MG.