Myasthenia gravis in pregnancy

OBJECTIVE: Our purpose was to review our experience with nine cases of myasthenia gravis complicating pregnancy.

METHODS: We reviewed the records of all patients discharged from the Vancouver Salvation Army Grace Hospital from January 1979 to January 1989 with an admission diagnosis of myasthenia gravis in pregnancy.

RESULTS: Nine patients delivered 11 infants. Four suffered antepartum exacerbations. The most severe of these, respiratory failure, occurred in a thymectomized patient. Labor was rapid and uncomplicated except for a single case of cephalopelvic disproportion delivered abdominally. We noted no puerperal exacerbations. Our solitary case of neonatal myasthenia gravis was managed in the special care nursery with intramuscular neostigmine given over a 16-day period.

CONCLUSION: There are no predictive factors that identify the mother at risk for peripartum exacerbation of myasthenia gravis or the infant at risk for neonatal myasthenia gravis. Optimal care for the parturient is achieved through a team approach involving the obstetrician, neurologist, and pediatrician.