Perinatal outcomes of pregnant women with myasthenia gravis and risk factors for disease exacerbation of myasthenia gravis
Objective To investigate the perinatal outcomes of pregnant women with myasthenia gravis(MG)and risk factors leading to disease exacerbation of MG during pregnancy and puerperium.Methods A total of 35 pregnant women with MG in West China Second University Hospital,Sichuan University and Women's and Children's Hospital,Xiamen University from January 2015 to December 2023 was selected as research subjects.These 35 patients had a total of 71 pregnancies,of which 39 were live births.These 39 live births were divided into two groups:deterioration group[n=6,with a worsened MG or myasthenic crisis(MC)during pregnancy and puerperium]and stable group(n=33,with a stable MG during pregnancy and puerperium).For patients with≥2 pregnancies,each pregnancy was considered as one case when grouping and data analysis.Clinical characteristics,pregnancy courses,perinatal outcomes,and MG prognosis were retrospectively collected and analyzed.Independent-samples t test or Mann-Whitney U test or Fisher's exact test was used to explore the potential risk factors for MG exacerbation.This study was approved by the Medical Ethics Committee of West China Hospital,Sichuan University(Ethics No.2019-536).Results ①Among the 35 pregnant women with MG,including 39 cases of live birth,3 cases of twin pregnancies and 42 neonates.Among the 39 cases of live birth,4 cases(10.3％)experienced a worsened MG during pregnancy and puerperium,2 cases(5.1％)developed MC,and the remaining 33 cases(84.6％)had a stable MG during pregnancy and puerperium.No serious obstetrical complications occurred.The gestational age of delivery was(38.5±2.4)gestational weeks.Preterm birth occurred in 7 cases(17.9％).28 cases(71.8％)were delivered by cesarean section.10 cases(10.3％)were admitted to intensive care unit(ICU)after delivery.2(4.8％)of the 42 neonates experienced transient neonatal MG(TNMG),and 8 neonates(19.0％)were admitted to neonatal ICU(NICU)after birth.There was no perinatal death.②The quantitative MG(QMG)score before pregnancy and the proportion of patients needing for medication to treat MG during pregnancy in deterioration group were 10.5 points(6.5 points,16.0 points)and 100.0％(6/6),respectively,which were both significantly higher than those 6.0 points(4.0 points,8.0 points)and 45.5％(15/33)in stable group(Z=-1.97,P=0.049;P=0.020).Conclusions Most pregnant women with MG could have a stable condition during pregnancy and puerperium and have good perinatal outcomes.However,those with a high QMG score before pregnancy or need medication to control MG during pregnancy and puerperium have an increased risk of disease exacerbation of MG,thus special attention should be paid to the pregnancy and puerperium management of these patients by clinicians.
Myasthenia gravisPregnancyPerinatal outcomesDisease progressionRisk factorsPregnant women
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