Ducci Renata D, Lorenzoni Paulo J, Kay Claudia S K, Werneck Lineu C, Scola Rosana H
Service of Neuromuscular Disorders, Division of Neurology, Department of Internal Medicine, Hospital de Clínicas, Universidade Federal do Parana (UFPR), Curitiba, Brazil.
Service of Neuromuscular Disorders, Division of Neurology, Department of Internal Medicine, Hospital de Clínicas, Universidade Federal do Parana (UFPR), Curitiba, Brazil.
Neuromuscul Disord. 2017 Apr;27(4):352-357. doi: 10.1016/j.nmd.2017.01.021. Epub 2017 Feb 1.
This study aimed to analyze the outcome and impact of pregnancy in women with myasthenia gravis (MG). Obstetric and clinical data were retrospectively analyzed before, during and after pregnancy. Predictors of outcome were studied. We included 35 pregnancies from 21 MG patients. In the course of MG symptoms in 30 pregnancies with live births, 50% deteriorated (mainly during the second trimester, p = 0.028), 30% improved, and 20% remained unchanged. The deterioration group had more frequent abnormal repetitive nerve stimulation (RNS) (p = 0.028) and lower myasthenia gravis composite (MGC) scores (p = 0.045) before pregnancy. The improvement group was associated with higher MGC scores (p = 0.012) before pregnancy. The no-change group was associated with longer duration of MG (p = 0.026) and normal RNS (p = 0.008) before pregnancy. The course of MG in the second pregnancy was different from that in the previous pregnancy in 65.3% of cases. Obstetric complications were reported in 20 pregnancies; the most common was preterm premature rupture of membranes (PPROM) (25.8%), and the most severe were abortion (11.4%) and fetal death (2.9%). Most of the patients delivered via caesarean section (66.7%). Spinal anesthesia was performed in 73.3%. Transient neonatal myasthenia gravis occurred in 12.9% of live-born infants, and no predictors were found. In conclusion, severity and duration of MG, RNS and treatment influence MG and pregnancy. Pregnant MG patients have greater rates of PPROM and caesarean delivery. Our data suggest that duration of MG, MGC and RNS before pregnancy may be useful in helping to predict the course of MG during pregnancy.
本研究旨在分析重症肌无力（MG）女性患者妊娠的结局及影响。对妊娠前、妊娠期间及妊娠后的产科和临床数据进行回顾性分析。研究了结局的预测因素。我们纳入了21例MG患者的35次妊娠。在30例有活产的妊娠过程中，MG症状方面，50%病情恶化（主要在妊娠中期，p = 0.028），30%病情改善，20%病情无变化。病情恶化组妊娠前异常重复神经刺激（RNS）更频繁（p = 0.028），重症肌无力综合（MGC）评分更低（p = 0.045）。病情改善组妊娠前MGC评分更高（p = 0.012）。病情无变化组妊娠前MG病程更长（p = 0.026）且RNS正常（p = 0.008）。65.3%的病例中，第二次妊娠时MG病程与前次妊娠不同。20次妊娠报告有产科并发症；最常见的是胎膜早破（PPROM）（25.8%），最严重的是流产（11.4%）和胎儿死亡（2.9%）。大多数患者通过剖宫产分娩（66.7%）。73.3%进行了脊髓麻醉。12.9%的活产婴儿发生短暂性新生儿重症肌无力，未发现预测因素。总之，MG的严重程度和病程、RNS及治疗会影响MG和妊娠。妊娠MG患者发生PPROM和剖宫产的几率更高。我们的数据表明，妊娠前MG的病程、MGC和RNS可能有助于预测妊娠期间MG的病程。
