Myasthenia gravis in pregnancy: a rare association with an unpredictable evolution – three cases presentation

Abstract

Myasthenia gravis is a neuro-immunological disease due to the blockage of motor plate post-synaptic receptors by anti-acetylcholine receptors antibodies, causing excessive fatigability of skeletal striated muscles. Thus, vital prognosis is engaged by swallowing disorders and respiratory distress related to pharyngeal striated and intercostal muscles damage. Myasthenia evolves by flare-ups, with two peaks of prevalence: first one, between 20 and 30 years-old with female predominance. Then after 40 years-old, sex ratio evens out. Therefore, association of myasthenia and pregnancy is not exceptional, hence the interest in knowing particularities of these pregnancies, to ensure optimal monitoring for both mother and child. Indeed, mother’s risk is myasthenia decompensation, while child’s risk is neonatal myasthenia gravis. We report three myasthenia and pregnancy cases, from prenatal period to peripartum, then we discuss in literature light, myasthenia gravis bidirectional influence on pregnancy, as well as impact of anti-myasthenic treatments on pregnancy.

Keywords

• myasthenia gravis
• neuromuscular disease
• autoimmune disorder
• pregnancy