Management of myasthenia gravis in pregnancy
- Shawn J Bird, MD
Shawn J Bird, MD
- Professor of Neurology
- University of Pennsylvania School of Medicine
- Irene P Stafford, MD
Irene P Stafford, MD
- Assistant Professor
- Department of Obstetrics and Gynecology
- Louisiana State University Health Science Center
- Gary A Dildy, III, MD
Gary A Dildy, III, MD
- Professor of Obstetrics and Gynecology
- Louisiana State University Health Sciences Center
- Section Editors
- Jeremy M Shefner, MD, PhD
Jeremy M Shefner, MD, PhD
- Section Editor — Neuromuscular Disease
- Professor and Chair of Neurology, Barrow Neurological Institute
- Professor of Neurology, University of Arizona, Phoenix
- Clinical Professor of Neurology, Creighton University
- Ira N Targoff, MD
Ira N Targoff, MD
- Section Editor — Muscle Disease
- Professor of Medicine, Section of Rheumatology
- University of Oklahoma Health Sciences Center
- Charles J Lockwood, MD, MHCM
Charles J Lockwood, MD, MHCM
- Section Editor — Obstetrics
- Senior Vice President, USF Health
- Dean, Morsani College of Medicine
- Professor, Obstetrics and Gynecology
- University of South Florida
Myasthenia gravis (MG) is an autoimmune disorder characterized by a fluctuating degree and variable combination of weakness in ocular, bulbar, limb, and respiratory muscles. 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 "Pathogenesis of myasthenia gravis" and "Clinical manifestations of myasthenia gravis" and "Diagnosis of myasthenia gravis" and "Treatment of myasthenia gravis".)
Myasthenia gravis (MG) is a relatively uncommon autoimmune disorder characterized by weakness and fatigability of skeletal muscles due to dysfunction of the neuromuscular junction. It can occur at any age, but there is 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 "Pathogenesis 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 commonly affects the ocular muscles, but it also involves a variable combination of bulbar, limb, and respiratory muscles. (See "Clinical manifestations of myasthenia gravis" and "Ocular myasthenia gravis".)
More than 50 percent of patients with MG present with ocular symptoms of ptosis and/or diplopia. Of those who present with ocular manifestations, about half will remain purely ocular. About 15 percent of patients present with bulbar symptoms. These include fatigable chewing, dysphagia, and dysarthria. Less than 5 percent present with proximal limb weakness alone. Involvement of the muscles of respiration produces the most serious symptoms in MG, such as respiratory insufficiency and pending respiratory failure, termed myasthenic crisis. (See "Myasthenic crisis".)
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