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Management of myasthenia gravis in pregnancy

Shawn J Bird, MD
Irene P Stafford, MD
Gary A Dildy, III, MD
Section Editors
Jeremy M Shefner, MD, PhD
Ira N Targoff, MD
Charles J Lockwood, MD, MHCM
Deputy Editor
John F Dashe, MD, PhD


Myasthenia gravis (MG) is an autoimmune disorder characterized by a fluctuating degree and variable combination of weakness in ocular, bulbar, limb, and respiratory muscles. It results from abnormal T cell regulation and the production of autoantibodies directed against nicotinic acetylcholine receptors on the neuromuscular end plate of skeletal muscle. Affected patients (most often young women and older men) usually present with fatigable weakness after repetitive muscle use.

This topic will discuss the effect of pregnancy on MG and management of MG in pregnancy. It will also briefly review clinical and treatment issues related to MG that are discussed in greater detail separately. (See "Clinical manifestations of myasthenia gravis" and "Diagnosis of myasthenia gravis" and "Treatment of myasthenia gravis".)


There are two clinical forms of myasthenia: ocular and generalized. In ocular myasthenia gravis (OMG), the weakness is limited to the eyelids and extraocular muscles. In generalized disease, the weakness may also commonly affect ocular muscles, but it also involves a variable combination of bulbar, limb, and respiratory muscles.

Patients who have detectable antibodies to the acetylcholine receptor (AChR) are called seropositive (SPMG) and those without are called seronegative (SNMG). About half of patients with purely OMG are seropositive, compared with nearly four-fifths of those with generalized disease. An important consideration is that about 10 to 15 percent of those with MG have an underlying thymoma.

Epidemiology — MG is a relatively uncommon disorder. It occurs at any age, but there tends to be a bimodal distribution to the age of onset with an early peak in the second and third decades (female predominance) and a late peak in the sixth to eighth decade (male predominance). (See "Clinical manifestations of myasthenia gravis", section on 'Epidemiology'.)


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Literature review current through: Feb 2017. | This topic last updated: Wed Apr 01 00:00:00 GMT+00:00 2015.
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