Pregnancy and neonatal outcomes in women with myasthenia gravis: two decades experience from a university clinic.

Objectives: Myasthenia gravis (MG) can increase pregnancy complications and cause adverse pregnancy outcome, while pregnancy can deteriorate the course of MG. The study evaluated pregnancy and neonatal outcomes in women with myasthenia gravis and factors that impact these outcomes.

Material and methods: The study included all 94 pregnant women with MG who were examined and delivered between 2000 and 2020 in our referral university clinic. Data on the mothers' medical history, symptoms and therapies during pregnancy along with overall condition after delivery were collected. Regarding neonates we registered gestational weeks and types of deliveries, anthropometric parameters, Apgar scores, symptoms, complications and therapies upon birth.

Results: Examined women were mostly primiparous with an average age of 30.81 ± 4.47 years. MG lasted for 4.3 ± 2.96 years before pregnancy and was treated with thymectomy and acetylcholinesterase inhibitors. Myasthenia gravis was mostly stable or improved during pregnancy, but deteriorated in 6.4% cases during and 3.2% cases after pregnancy. The predictor of maternal condition after delivery was MG symptoms severity during pregnancy. Delivery mostly occurred in term (84.3%). Cesarean sections rate was 37.2%. All investigated newborns were in good condition upon birth (average Apgar score 8.75 ± 0.57). Although 12.8% of newborns had mild symptoms of transient neonatal MG, none had any consequences. A higher MG class and an earlier week of delivery were predictors for complications of neonates upon birth.

Conclusions: With close monitoring and appropriate current therapies pregnancy of MG patients can be uneventful with favorable outcomes for both mothers and neonates.