Summary of previously published studies of myasthenia in pregnancy
| Lead author/date | Number of patients in study | Drug treatment | Course during pregnancy | Course after delivery | Mode of delivery | Transient neonatal myasthenia gravis | Other comments |
|---|---|---|---|---|---|---|---|
| Plauché (1991)4 | 322 pregnancies in 225 women | Not stated | No change in 31.7% during pregnancy or puerperium, relapse in 41%, remission in 29% | 29.8% exacerbation with 4% death rate | Pre-1963 CS 5.6%; post-1963 13.5%. 15.4% forceps. | 16.1% (14.9% definite) | Large review series |
| Batocchi* (1999)5 | 64 pregnancies in 47 women | Majority 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% worse | CS rate 30%, most for obstetric reasons | 9% | 42 had thymectomy preconception: hyperplasia in 35, thymoma 4 |
| Djelmis (2002)6 | 69 pregnancies in 65 women | 23% 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% worse | Vaginal in 83%, vacuum extraction in 9% and CS in 17% (all but one for obstetric reasons). | 30% | 38.5% had thymectomy prepregnancy |
| Hoff (2003)7 | 127 births in 79 women (1967–2000) | Not recorded prior to 1999, thereafter PYR alone in 54.5%. | Not stated | Not stated | Caesarean 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)8 | 49 births in 37 asymptomatic/in remission mothers | Not stated | Not stated | Not stated | Protracted labour. CS 14.6%, forceps/vacuum 8.2% | Increased perinatal mortality (6.1%) | |
| Hoff (2007)9 | 135 births in 73 mothers | Medication in 68% but in only 45% throughout pregnancy: PYR alone apart from one on ST and three crisis management | 10% worse | Not stated | Protracted labour 19% | 19% | Risk of TNMG halved if mother had had a thymectomy |
| Wen (2009)10 | 163 women | Not stated | Not stated | Not stated | CS 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)11 | Anaesthetic management of 17 women | Not stated | 4 worse, 8 no change, 3 first presentation | Not stated | CS in 5 (of 8 stable) women | None reported |
*Prospective study.
AZA, azathioprine; CS, caesarean section; PYR, pyridostigmine; ST, corticosteroids; TNMG, transient neonatal MG.