Myasthenia gravis in pregnancy: Systematic review and case series

Harrison Banner; Kirsten M Niles; Michelle Ryu; Mathew Sermer; Vera Bril; Kellie E Murphy

doi:10.1177/1753495X211041899

Myasthenia gravis in pregnancy: Systematic review and case series

Obstet Med. 2022 Jun;15(2):108-117. doi: 10.1177/1753495X211041899. Epub 2022 Jan 10.

Authors

Harrison Banner¹, Kirsten M Niles¹, Michelle Ryu², Mathew Sermer¹, Vera Bril³, Kellie E Murphy¹

Affiliations

¹ Division of Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Canada.
² Sidney Liswood Library, Mount Sinai Hospital, University of Toronto, Canada.
³ Division of Neurology, University Health Network, University of Toronto, Canada.

Abstract

Background: Myasthenia gravis is an autoimmune disease which can impact pregnancy.

Methods: Six databases were systematically searched for studies with at least five subjects reporting pregnancy outcomes for women with myasthenia gravis in pregnancy. Assessment of bias was performed for all included studies. Forty-eight cases from our own centre were also included in the analysis.

Results: In total, 32 publications met inclusion criteria for systematic review, for a total of 33 unique data sets including 48 cases from our institution. Outcome data was available for 824 pregnancies. Spontaneous vaginal delivery occurred in 56.3% of pregnancies. Overall risk of myasthenia gravis exacerbation was 33.8% with a 6.4% risk of myasthenic crisis in pregnancy and 8.2% postpartum. The incidence risk of transient neonatal myasthenia gravis was 13.0%.

Conclusions: The current systematic review provides the best estimates of risk currently available to aid in counselling women with myasthenia gravis in pregnancy.

Keywords: Myasthenia gravis; obstetric complications; obstetric outcomes; pregnancy; systematic review.