Pregnancy, Delivery and Lactation in Patients with Myasthenia Gravis

Myasthenia gravis is not a contraindication of pregnancy.

The condition of sick women varies during pregnancy and may improve, worsen or stabilize. The condition is more likely to worsen in the first 3 months of pregnancy, while the condition is more likely to worsen in the last 3 months of second pregnancy and postpartum. However, myasthenia gravis is not a contraindication of pregnancy.

Spontaneous abortion caused by myasthenia gravis is rare. Cholinesterase inhibitors and prednisone are safe for the fetus. At present, there is no evidence that pregnant women taking large doses of prednisone will have adverse effects on their infants. Azathioprine, cyclophosphamide, etc. may have teratogenic effects and must be stopped before pregnancy. Although there is no large-scale clinical trial to confirm whether propofol or plasma exchange has effects on pregnant women, the current data show that it is safe.

Will the delivery mode of pregnant women with myasthenia gravis be affected?

In outpatient clinics, women with myasthenia gravis often come to ask what to do if they are pregnant and give birth. Patients and their families will take it for granted that since they are myasthenia, they will definitely not have the strength to give birth to the child during delivery and hope to have cesarean section.

Is this really the case?

In fact, the uterus is composed of smooth muscle, It is not affected by acetylcholine receptor antibodies, Therefore, vaginal delivery is still recommended for pregnant women with myasthenia gravis. However, it must be noted that many skeletal muscle contractions (including abdominal muscles, diaphragm and pelvic floor muscles) will be involved in the second stage of labor. It is necessary to induce labor by forceps or fetal head suction, because skeletal muscle will be affected by acetylcholine receptor antibodies to produce weakness.

Because the operation itself is a kind of stress to myasthenia gravis, generally only when pregnant women appear obstetric indications to consider cesarean section. In addition, it is worth mentioning that epidural anesthesia can be used during delivery and delivery, and patients do not have to worry too much. Magnesium sulfate can be used with caution when dealing with preeclampsia, and barbiturates can be selected.

Instructions for Medication of Myasthenia Gravis Women during

Mothers with myasthenia gravis can be breastfed. Through the analysis of blood and milk samples of mothers, it is found that bromopyrimidine and steroid hormones are rarely distributed in milk and can be taken during lactation. If breast-feeding is carried out after taking hormones for 4 hours, the impact on infants will be smaller.

The total amount of azathioprine entering the infant through the mother’s body is only 1% of that of the mother’s body. It is safe to take azathioprine during lactation and can be recommended to the mother.

Cyclosporine A is excreted from milk, but current research observation shows that taking cyclosporine does not increase nephrotoxicity or other side effects.

Cyclophosphamide will enter milk and cause immunosuppression and nephrotoxicity to infants. It is not recommended.

The use of rituximab during lactation has not been reported at present. Relevant studies show that the total amount of tacrolimus entering the fetus through milk is also very small, only 0.05%-0.6% of the maternal concentration. Although the safety still needs more studies to confirm, it has certain prospects.

Author: Huashan myopathy group

The article was reprinted by Clove Garden authorized by the author.