Myasthenia gravis in pregnancy: a case report


  • Lata Assudani Department of Obstetrics and Gynaecology, KEM Hospital, Mumbai, Maharashtra, India
  • Ashish Notwani Department of Paediatrics, KEM Hospital, Mumbai, Maharashtra, India



Myasthenia gravis, Chronic hypertension


Myasthenia gravis is an autoimmune neuromuscular disorder characterized by weakness and fatigue of skeletal muscles of the face and extremities. It affects the people of both sexes and all ages, but twice as many female patients are affected as male patients. Myasthenia gravis usually strikes women in their third decade of life. Although disease course is variable, pregnant patients face risks of exacerbation, respiratory failure, adverse drug response, crisis and death.

Because the severity of symptoms, as well as maternal mortality, is highest in the first 2 years following onset of myasthenia gravis, it is advisable for women to delay pregnancy for at least 2 years following diagnosis. Severity of symptoms and risk of maternal mortality is lowest 7 years after onset of the disease. We report a case of 26-year-old patient with G2P1IUFD1 at 37 weeks of gestation with myasthenia gravis.


Djelmis J. Sostarko M, Mayer D, Ivanisevic M. Myasthenia gravis in pregnancy: report on 69 cases. Eur J Obstet Gynecol Reprod Biol. 2002:104(1):21-5.

Ferrero S, Esposito F, Biamonti M, bentivoglio G, ragni N. Myasthenia gravis during pregnancy. Expert rev Neurother. 2008:8(6):979-88.

Ferrero S Pretta S, Nicoletti A, Petrera P, Ragni N. Myasthenia gravis: management issues during pregnanacy. Eur J Obstet Gynecol. 2005:121(2):129-38.

Da Silva FC, Do Cima Lc, de Sa RAM. Myasthenia gravis and pregnancy. In Minagar A, editor. Neurological disorders and pregnancy. Burlington, MA: Elsevier; 2011: pp.55-68.

Berlit JM, Dalveit AK, Gilhus NE. Myasthenia gravis in pregnancy and birth: identifying risk factors, optimizing care. Eur J Neurol. 2007:14(1):38-43.

Burke ME. Myasthenia gravis and pregnancy. J perinat neonatl nurs. 1993;7(1):11-21.

Naccasha N, Gervasi MT, Chaiworapongsa T, Berman S, Yoon BH, Maymon E, et al. phenotypic and metabolic characteristics of monocytes and granulocytes in normal pregnancy and maternal infection. AM J Obstet Gynecol. 2001;185(5):1118-23.

To WK, Cheung RT. Neurologic disorders in pregnancy. Hong Kong Med J. 1997;3:400-8.

Sclezinger NS. Pregnancy in myasthenia gravis and neonatal myasthenia gravis. Am J Med. 1955,19:718-20.

Mitchell PJ, Bebbington M. Myasthenia gravis in pregnancy. Obstet gynecol. 1992,80(2):178-81.

Papazian O. Transient neonatl myasthenia gravis. J Child Neurol. 1992;7(2):135-41.

Picone O, Audibert F, Gajdos P, Fernandez H. Myasthenia gravis and pregnancy: report of 13 cases. J Obstet Gynecol Biol Reprod (paris). 2003;32(7):645-59.

Batocchi AP, Majoloni L, Evoli A, Lino MM, Minisci C, Tonali P. Course and treatment of myasthenia gravis during pregnancy. Neurology. 1999;52(3):447-52.

Gilhus NE, Owe JF, Hoff JM, Romi F, Skeie GO, Aarli JA. Myasthenia gravis: a review of available treatment approaches. Autoimmune disease 2011;2011:847393.

Berlit S, Tuschy B, Spaich S, Sutterlin M, Schaffelder R. Myasthenia gravis in pregnancy: a case report. Case rep obstet gynecol 2012;2012:736024.

Dominovic-Kovacevic A, Ilic T, Vukojevic Z. Myasthenia gravis and pregnancy- case report. Curr Top Neurol Psychiatry Relat Discip. 2010:18(4):40-3.

Briggs G, Freeman R, Yaffe S. drugs in pregnancy and lactation. Philadelphia, PA: Lippincott Williamns and Wilkins; 2008.

Hoff JM, Daltveit AK, Gilhus NE. Myasthenia gravis in pregnancy and birth: identifying risk factors, optimizing care. Eur J Neurol. 2007;14:38-43.

Park-Wyllie L, Mazzotta P, Pastuzak A, Moretti ME, Beique L, Hunnisett L, et al. birth defects after maternal exposure to corticosteroids: prospective cohort study and meta nanlysis of epidemiological studies. Teratology. 2000;62(6):385-92.

Goldstien LH. Pregnancy outcome of women exposed to azathioprine during pregnancy. Birth Defects res A clin mol teratol. 2007:79(10):696-701.

Matalon ST, Ornoy A, Lisher M. Review of the potentila effects of three commonly used antineoplastic and immunosuprresive drugs (cyclophosphamide, azathioprine, doxorubicin on the embryo and placenta) reprod toxicol. 2004;18(2):219-30.

Ostensen M, Lockshin M, Doria A, Valesini G, Meroni P, Gordon C, et al. update on safety during pregnancy of biological gents and some immunosuppressive and anti-rheumatic drugs. Rheumatology. 2008; 47.

Voulgaris E. Cancer and pregnancy: a comprehensive review. Surg oncol. 2011;20(4):e175-85.

Pisoni CN, De Cruz DP. The safety of mycophenolate mofetil in pregnancy. Expert Opin Drug Saf. 2008;7(3):219-22.

Gold R, Hohfeld R, Toyka K. Review: progress in the treatment of myasthenia gravis. Their Adv Neurol Dis. 2008;1(2):99-114.






Case Reports