Myasthenia Gravis During Pregnancy | Risks And Management

Myasthenia gravis is an autoimmune neuromuscular disorder.

It is due to the immune system's misdirected attack on the acetylcholine receptors at the neuromuscular junction.

Which prevents nerve impulses from reaching the muscles and results in muscle weakness and tiredness, primarily in the voluntary muscles.

The actual cause is yet unknown, but environmental variables and genetic predisposition may work together to promote its development.

Women are affected by it twice as frequently as men are, and it usually strikes women in their second and third decades of life.

Symptoms of myasthenia gravis during pregnancy

Several symptoms are associated with myasthenia gravis during pregnancy.

Such as drooping eyelids, double vision, trouble swallowing, and issues with speaking, eating, swallowing, and breathing.

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Risks of myasthenia gravis during pregnancy

Although myasthenia gravis during pregnancy can occasionally have negative effects on mother and baby.

There have been several cases of women with myasthenia graves during pregnancy having successful stories.

Risks and considerations for the mother

The effects of pregnancy on the severity of myasthenia gravis are variable.

While some women with myasthenia gravis during pregnancy may experience a few problems, others may develop complications.

Sometimes the symptoms of myasthenia gravis can get worse due to immune system changes that happen during pregnancy.

The immune system's disruption caused by normal and abnormal hormonal imbalance levels is the primary cause.

Women with stable myasthenia gravis during pregnancy can generally expect a normal pregnancy and delivery.

However, close monitoring is essential by multidisciplinary care, and a team of healthcare professionals.

Pregnant women with myasthenia gravis, experience more weakness and fatigue.

Particularly in the voluntary muscles such as the muscles used for breathing, leading to respiratory failure.

The increased weight, the effort of pregnancy, fluctuations in hormonal levels, and the physical demands of pregnancy can impact myasthenia gravis symptoms.

Some women with myasthenia gravis during pregnancy may even experience a myasthenic crisis.

Risks and considerations for the baby

In rare cases can develop transient neonatal myasthenia gravis due to maternal antibodies associated with myasthenia gravis.

That can cross the placenta and affect the baby's muscle strength.

The baby after delivery can sometimes require intense monitoring and even medication for blocking these antibodies.

Premature delivery occurred in 7.4% of 54 patients, and 30% of these cases involved cesarean delivery.

How to manage myasthenia gravis during pregnancy?

The management of myasthenia gravis during pregnancy requires special skills.

Depending on the severity of myasthenia gravis, a customized treatment plan is required during pregnancy.

Medications for myasthenia gravis during pregnancy

1) Acetylcholinesterase enzyme inhibitors

Pyridostigmine or, neostigmine are usually the first line of treatment of myasthenia gravis during pregnancy and are considered low-risk during pregnancy.

They inhibit the breakdown of acetylcholine at the neuromuscular junction, help manage the symptoms of myasthenia gravis, and maintain muscle function.

2) Corticosteroids

Prednisone or, prednisolone helps to reduce inflammation and suppress the immune system to prevent exacerbations of myasthenia gravis symptoms.

They continue to be the most commonly used drug for the treatment of myasthenia gravis during pregnancy, either alone or with acetylcholinesterase inhibitors.

Corticosteroids are typically safe for the treatment of myasthenia gravis during pregnancy, but the lowest effective dose should be used due to possible infant health risks associated with higher doses.

3) Alternate immunosuppressant drugs

Such as azathioprine which is considered a non-steroidal drug of choice for the treatment of myasthenia gravis during pregnancy

Used for long-term treatment of myasthenia gravis, helps reduce steroid dosage. But, should only be used if necessary during pregnancy, as they pose a higher risk of complications.

Different approaches to treat myasthenia gravis during pregnancy

Alternative treatments for myasthenia gravis during pregnancy may be considered.

However, it is essential to consult with a healthcare provider to determine if these treatments are necessary and safe during pregnancy.

1. Acupuncture

This traditional Chinese medicine technique has been used to treat different conditions, including muscle weakness and fatigue.

2. Chiropractic care

This alternative therapy enhances general health and well-being by realigning the spine and nerve system.

3. Physical therapy

A physical therapist can work with women with myasthenia gravis during pregnancy to develop individualized exercise plans that help maintain muscle strength and function, as well as improve overall mobility and flexibility.

4. Proper nutrition

Adequate nutrition is essential for maintaining muscle function and overall health. A diet rich in minerals, vitamins, and essential nutrients may help boost muscle health and reduce the severity of the symptoms of myasthenia gravis during pregnancy.

5. Relaxation techniques

Techniques such as deep breathing, and meditation, may help manage stress and anxiety related to myasthenia gravis during pregnancy.

Avoiding trigger factors

It is crucial to avoid medications and factors that can exacerbate myasthenia gravis during pregnancy.

Infections should be treated quickly to avoid exacerbations.

Reduce your stress levels, both mentally and physically, as much as you can.

You should see a doctor immediately if any signs of a myasthenia gravis flare happen.

Additionally, women with myasthenia gravis during pregnancy should avoid drugs like:

-Narcotics.

-Inhalation anesthetics.

-Barbiturates.

-Tranquilizers.

-Magnesium.

-Lithium salts.

-Beta-adrenergic drugs.

Close monitoring

It is essential to work closely with a healthcare team to create a customized treatment plan.

That takes into account the specific needs and concerns of women with myasthenia gravis during pregnancy.

This ensures that any complications are identified early and efficiently to guarantee a safe pregnancy and reduce the possibility of complications.

Myasthenia gravis and delivery plans

Planning for the delivery is also an important consideration for women with myasthenia gravis during pregnancy.

In most situations, a vaginal birth is feasible; but, in more severe cases, an elective C-section may be advised.

To avoid excessive muscle strain that could trigger a myasthenia gravis crisis.

Summary

Myasthenia gravis during pregnancy can be a challenging combination.

However, with a multidisciplinary approach and careful clinical management, many women with myasthenia gravis can have successful pregnancies and deliveries.