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World J Obstet Gynecol. Dec 6, 2020; 9(1): 1-10
Published online Dec 6, 2020. doi: 10.5317/wjog.v9.i1.1
Myasthenia gravis and pregnancy
Goun Je, Mehdi Ghasemi
Goun Je, Mehdi Ghasemi, Department of Neurology, University of Massachusetts Medical School, Worcester, MA 01655, United States
Author contributions: Je G and Ghasemi M made contribution to the conception and design of the review paper’s content and literature review; Je G wrote the initial draft of the paper; Ghasemi M and Je G critically reviewed, edited and finalized the paper for submission.
Conflict-of-interest statement: The authors declare no conflict of interest related to this work.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mehdi Ghasemi, MD, Assistant Professor, Department of Neurology, University of Massachusetts Medical School, 55 Lake Avenue North, Room S5-770, Worcester, MA 01665, United States. m82.ghasemi@gmail.com
Received: May 22, 2020
Peer-review started: May 22, 2020
First decision: October 6, 2020
Revised: November 9, 2020
Accepted: November 17, 2020
Article in press: November 17, 2020
Published online: December 6, 2020
Abstract

Myasthenia gravis (MG) is an autoimmune disorder of neuromuscular junction that has higher incidence in younger women than men, which could be related to differences in sex hormones physiology and immune system functioning between males and females. MG can first present during pregnancy and variably affect pregnancy, labor, and postpartum period. In this paper, we had an updated overview on our understanding about MG presentation and its effect on pregnancy and vice versa, therapeutic options for MG pregnant women, management of pregnancy or labor complications in MG patients, and finally fetal and neonatal considerations in MG pregnant women. A multidisciplinary approach, involving obstetricians/gynecologists, neurologists, and anes-thesiologists, plays a pivotal role in improving the clinical outcomes in both MG mothers and their infants during pregnancy, delivery and postpartum.

Keywords: Pregnancy, Myasthenia gravis, Delivery, Postpartum, Transient neonatal myasthenia gravis, Pyridostigmine

Core Tip: Myasthenia gravis (MG) is an autoimmune disorder of the neuromuscular junction that overall has higher incidence in women than men. This disease can variably affect pregnancy; and specific considerations need to be taken by a multidisciplinary team (including obstetricians/gynecologists, neurologists, and anesthesiologists) in pregnant women during their pregnancy, delivery, and post-partum period. We herein discuss about our understanding about MG presentation and its effect on pregnancy and vice versa, safe therapeutic approaches for MG as well as pregnancy/Labor complications, and finally specific fetal and neonatal considerations in MG pregnant women.