Subscribe to RSS
![](/products/assets/desktop/img/oa-logo.png)
DOI: 10.1055/s-0043-122651
Myasthenia Gravis: Family Planning, Pregnancy and Delivery
Publication History
Publication Date:
21 February 2018 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00033101/201801/lookinside/thumbnails/176_10-1055-s-0043-122651-1.jpg)
Abstract
Myasthenia gravis affects women younger than 40 about three times more frequently than men. Therefore, questions about family planning, pregnancy and delivery are common for these patients and their treating physicians. The outcome for mother and child depends a good deal on knowledge of the influence of pregnancy on myasthenia, therapy options, the relationship between the disease and delivery and the newborn. This paper provides an overview of these situations to support women with myasthenia gravis and their physicians in their decision-making regarding desire for children, the course of pregnancy and delivery and neonatal considerations. With thorough advice, good preparation and support of partners and families, the desire for a child can come true for patients with myasthenia gravis. Taking special precautions and with interdisciplinary treatment, the risks for mother and child can be minimized.
-
References
- 1 Köhler W, Sieb JP. Myasthenia gravis. 4. Auflage. Bremen: UNI-MED Verlag; 2012
- 2 Ohlraun S, Hoffmann S, Klehmet J. et al. Impact of myasthenia gravis on family planning: How do women with myasthenia gravis decide and why?. Muscle Nerve 2015; 52: 371-379
- 3 Klehmet J, Ohlraun S, Meisel A. Myasthenia gravis und Schwangerschaft. Akt Neurol 2014; 41: 447-453
- 4 Klehmet J, Dudenhausen J, Meisel A. Verlauf und Behandlung der Myasthenia gravis in der Schwangerschaft. Nervenarzt 2010; 81: 956-962
- 5 Leitenberger F, Strowitzki T, Ortmann O. Klinische Endokrinologie für Frauenärzte. 5. Auflage. Heidelberg: Springer Verlag; 2014
- 6 Gnoth C, Mallmann P. Perikonzeptionelle Frauenheilkunde. Heidelberg: Springer-Verlag; 2014: 153-155
- 7 Alexander H, Kaczmarczyk MA, Schiwek E. OvulaRing. Das Cyclofertilogramm (CFG) zur exakten Zyklus- und Fertilitätsdiagnostik. Ärztebl Sachsen 2015; 26: 539 - 542
- 8 Sieb JP. Myasthenie und Schwangerschaft. Newsletter Myasthenie Kolloqium 2006; 2 Temmler ZNS
- 9 Röhmer T, Görentzlehner G. Kontrazeption mit OC in 160 Problemsituationen. Berlin: de Gruyter Verlag; 2012
- 10 www.embryotox.de Arzneimittelsicherheit in Schwangerschaft und Stillzeit, Pharmakovigilanz- und Beratungszentrum für Embryonaltoxikologie; Augustenburger Platz 1, 13353 Berlin
- 11 Hoff JM, Daltveit AK, Gilhus NE. Myasthenia gravis: Consequencies for pregnancy, delivery, and newborn. Neurology 2003; 61: 1362-1366
- 12 Norwood Dhanjal M, Hill M. et al. Myasthenia in pregnancy: Best practice guidelines from a UK multispecialty working group. J Neurol Neurosurg Psychiatry 2014; 85: 538-543
- 13 de Meel R, Lipka AF. van Zwet Prognostic factors for exacerbation and emergency treatments in myasthenia gravis. J Neuroimmunology 2015; 282: 123-125
- 14 Hoff JM. Maternal myasthenia gravis: A couse for arthrogryposis multiplex. J Child Orthop 2015; 9: 433-435
- 15 Hacohen Y, Jacobson LW, Byrne S. et al. Fetal acetylcholine receptor inactivation syndrome: A myopathy due to maternal antibodies. Neurol Neuroimmunol Neuroinflamm 2014; 2: e57
- 16 Reuner U, Dinger J. Lambert-Eaton-Syndrom und Schwangerschaft. Newsletter Myasthenie Kolloqium 2011; 1 Temmler ZNS
- 17 Hoffmann S, Kohler S, Zieglr A. Glucocorticoids in myasthenia gravis- if, when, how, and how much?. Acta Neurol Scand 2014; 130: 211-221
- 18 Varner M. Myasthenia gravis and pregnancy. Clin PObst Gynecolo 2013; 56: 372-381
- 19 Armenti V, Radomski JS, Moritz MJ. et al. Report from the National Transplantation Pregnancy Regestry (NTPR): Outcomes of pregnancy after transplantation. Clin Transpl 2003; 131-141
- 20 Moskovitz DN, Bodian C, Chapman ML. et al. The effect on the fetus of medications used to treat pregnant inflammatory bowel-disease patient. Am J Gastroenterol 2004; 99: 656-661
- 21 Janssen NM, Genta MS. The effects of immunosuppressive and anti-inflammatory medications on fertility, pregnancy and lactation. Arch Intern Med 2000; 160: 610-619
- 22 Gutierrez JC, Hwang K. The toxicity of methotrexate in male fertility and paternal teratogenicity. Expert Opin Drug Metab Toxicol 2017; 1: 51-58
- 23 Tian N, Yu J, Zhang S. et al. Effects of methotrexate on the qualitiy of oocyte maturation in vitro. Eur Biophy J 2017; DOI: 10.1007/s00249-017-1254-2 [Epub ahead of print].
- 24 Stieglbauer K, Pichler R, Topakian R. 10-year outcomes after rituximab for myasthenia gravis: Efficacy, safety, costs of inhospital care, and impact on childbearing potential. J Neurol Sci 2017; 375: 241-244
- 25 Ostensen M. The use of biologics in pregnant patients with rheumatic disease. Expert Rev Clin Pharmacol 2017; 6: 661-669
- 26 Hallstensen RF, Bergset S, Foss S. et al. Eculizumab treatment during pregnancy does not affect the complement system activity of the newborn. Immunobiology 2015; 220: 452-459
- 27 Schwab S, Krieger D, Müllges W. et al. Neurologische Intensivmedizin. Berlin: Springer Verlag; 1999
- 28 Walz R, Lubbe N, Walz K. et al. Muskelrelaxation mit Atracurium bei Myasthenia gravis. Anaesthesiol Reanim 1996; 21: 43-46
- 29 Blobner M, Mann R. Anästhesie bei Patienten mit Myasthenia gravis. Anaesthesist 2001; 50: 484-493
- 30 Banerjee A, Wilson I.Anaesthesia and myasthenia gravis. anaesthesia tutorial of the week, World Federation of Societies of Anaestesiologists 2008 http:/totw.anaestesiologists.org/2008/12/14/anaesthesiaand-myasthenia-122/ (accesed online:10/05/2011)
- 31 Gambling D, Douglas M, McKay R. Obstetric anaestesia and uncommon disorders. Cambridge UK: Cambridge University Press; 2008
- 32 Boldingh M, Maniaol AH, Brunborg C. et al. Increased risk for clinical onset of myasthenia gravis during the postpartum period. Neurology 2016; 87: 2039-2045
- 33 Statland JM, Ciafaloni E. Myasthenia gravis. Five new things. Neurol Clin Pract 2013; 3: 126-133
- 34 Licht U, Model P, Kribs S.. Transiente neonatale Myasthenia gravis. Nervenarzt 2002; 73: 774-778
- 35 Tagher RJ, Baumann R, Desai N. Failure of intravenously administered immunoglobulin in the treatment of neonatal myasthenia gravis. J Pediatr 1999; 134: 233-235
- 36 Bundesministerium für Familie, Senioren, Frauen und Jugend: Assistenz bei der Familienarbeit für behinderte und chronisch kranke Eltern. broschuerenstelle@bmfsfj.bund.de