Gilhus Nils Erik
Department of Clinical Medicine, University of Bergen, Bergen, Norway.
Department of Neurology, Haukeland University Hospital, Bergen, Norway.
Front Neurol. 2020 Jun 12;11:554. doi: 10.3389/fneur.2020.00554. eCollection 2020.
Myasthenia gravis (MG) with onset below 50 years, thymic hyperplasia and acetylcholine receptor (AChR) antibodies is more common in females than in males. For a relatively large group of MG patients, pregnancy represents therefore an important question. The muscle weakness, the circulating autoantibodies, the hyperplastic thymus, the MG drug treatment, and any autoimmune comorbidity may all influence both mother and child health during pregnancy and also during breastfeeding in the postpartum period. Mother's MG remains stable in most patients during pregnancy. Pyridostigmine, prednisolone, and azathioprine are regarded as safe during pregnancy. Mycophenolate, methotrexate and cyclophosphamide are teratogenic and should not be used by women with the potential to become pregnant. Rituximab should not be given during the last few months before conception and not during pregnancy. Intravenous immunoglobulin and plasma exchange can be used for exacerbations or when need for intensified therapy. Pregnancies in MG women are usually without complications. Their fertility is near normal. Vaginal delivery is recommended. MG patients have an increased rate of Cesarean section, partly due to their muscle weakness and to avoid exhaustion, partly as a precaution that is often unnecessary. Around 10% of the newborn develop neonatal myasthenia during the first few days after birth. This is transient and usually mild with some sucking and swallowing difficulties. In rare cases, transplacental transfer of AChR antibodies leads to permanent muscle weakness in the child, and arthrogryposis with joint contractures. Repeated spontaneous abortions have been described due to AChR antibodies. MG women should always give birth at hospitals with experience in newborn intensive care. MG does not represent a reason for not having children, and the patients should be supported in their wish of becoming pregnant.
50岁以下发病的重症肌无力（MG）、胸腺增生和乙酰胆碱受体（AChR）抗体在女性中比男性更常见。因此，对于相对较大的MG患者群体来说，怀孕是一个重要问题。肌无力、循环自身抗体、增生的胸腺、MG药物治疗以及任何自身免疫性合并症，都可能在孕期以及产后母乳喂养期间影响母婴健康。大多数患者的母亲MG在孕期保持稳定。吡啶斯的明、泼尼松龙和硫唑嘌呤在孕期被认为是安全的。霉酚酸酯、甲氨蝶呤和环磷酰胺具有致畸性，有怀孕可能的女性不应使用。利妥昔单抗在受孕前最后几个月以及孕期均不应使用。静脉注射免疫球蛋白和血浆置换可用于病情加重或需要强化治疗时。MG女性的妊娠通常无并发症。她们的生育能力接近正常。建议经阴道分娩。MG患者剖宫产率增加，部分原因是其肌无力以及为避免体力消耗，部分是作为一种往往不必要的预防措施。约10%的新生儿在出生后的头几天会出现新生儿肌无力。这是暂时的，通常较轻，伴有一些吸吮和吞咽困难。在极少数情况下，AChR抗体经胎盘转移会导致儿童永久性肌无力以及关节挛缩的关节弯曲。已有因AChR抗体导致反复自然流产的报道。MG女性应始终在有新生儿重症监护经验的医院分娩。MG并非不生育的理由，应支持患者怀孕的意愿。
