Myasthenia Gravis And Pregnancy: 8 Questions You Have

Myasthenia gravis can change your path in unpredictable ways. Every aspect of your day-to-day life can be affected: from your job and hobbies to the way you eat and even sleep. You may need to reconsider things you took for granted or delay plans you had for your family or career. Among those plans that may need to be postponed is pregnancy.

The high prevalence of MG in women in their 20s and 30s makes family planning a difficult topic for many myasthenia patients. Although the autoimmune disease does not affect fertility, it can make the pregnancy itself harder. If you recently got diagnosed with MG or if you have been living with it for a few years now but you recently started thinking about having your first or maybe one more child, you probably have a lot of questions and concerns.

As with everything else, we advise you to turn to your treatment team with any particular worries because they know your MG and can give you more accurate information. What you can find here are some general answers to common myths and concerns because on the FindMeCure blog we not only talk about recent advancements in medicine but we also like to help you make informed decisions about your health. Before you start planning your family you might be wondering…

“What about my fertility?”

Myasthenia gravis doesn’t affect fertility. Provided everything else is in the norm, you should have just as high of a chance of getting pregnant as any other woman your age.

“Does MG lead to miscarriages or premature births?”

Generally speaking, MG doesn’t pose a great risk to your pregnancy. Research shows that it doesn’t increase the risk of spontaneous abortions or premature babies. However, the risk for you is highest during the first year after being diagnosed with MG. This may be due to the higher risk of experiencing a myasthenic crisis and respiratory failure in the one year following the onset of symptoms. Women considering pregnancy are advised to start trying at least two years after they first experience symptoms. If you are willing to delay having a child for longer, you should know that the safest time is 7 years after onset.

“Will my symptoms worsen during pregnancy?”

It’s hard to predict whether you’ll experience a disease flare-up during pregnancy. Though there are some general percentages known to medical professionals, keep in mind that every pregnancy is different. You may be in remission for your second and third trimester with your first pregnancy and then symptoms may worsen with your second. As a general rule, for 41% of women with MG symptoms worsen, 30% experience no difference and in 29% remission occurs. Normal immunosuppressive changes during the later stages of pregnancy are probably responsible for the improvement of symptoms but whether that will be your case is hard to predict. Your treatment team, however, may be able to give you a more satisfying answer according to your disease pattern and your response to treatment.

“Is my baby at risk?”

Transient neonatal MG requires close monitoring and can be very stressful and even scary for new mothers. Though it is reversible after 3 weeks, during this time the baby may develop symptoms that include respiratory problems, muscle weakness and poor sucking. Transient neonatal MG occurs in 10% to 20% of cases due to antibodies crossing the placenta in the second and third trimester of pregnancy. As challenging as it can be, it’s important to remember that the symptoms will eventually disappear as the antibodies degrade.

“Is natural delivery possible?”

Myasthenia gravis does not affect the muscles of the uterus but it does weaken the muscles needed to push. However, for women with MG who don’t experience any complications during pregnancy vaginal delivery is recommended as surgery can be very stressful and hard to recover from. Women who don’t report being in remission may need assistance during labour in the form of forceps or vacuum extraction.

“Should I consider thymectomy before becoming pregnant?”

The answer to this question will depend on how your MG manifests and develops, how you respond to treatment and other factors that your treatment team will take into consideration before recommending or ruling out thymectomy as an option. However, there is evidence to suggest that thymectomy prior to pregnancy can lower certain risks like transient neonatal MG making it a route you need to at least address with your primary physician.

“Will I need to discontinue my treatment?”

It’s strongly recommended that you don’t. You might need to introduce some changes and this is certainly an issue you need to address with your treatment team. According to an NIH report, most drugs used for the treatment of MG come with no considerable risks for the baby – even the ones that cross the placenta. However, lowering doses when possible might be a good choice and avoiding some corticosteroids in the first 12 weeks could be something to ask your doctor about. For some women undergoing thymectomy before becoming pregnant can lower the need for medication.

“What are other things I should keep in mind?”

During pregnancy, you should try and avoid stress as much as possible. That’s even truer if you have myasthenia gravis since stress can affect your symptoms as well. Avoiding stress may look like having more rest and prioritizing your wellbeing over trying to be productive. It also looks like lowering your expectations: as long as both you and your baby are healthy, it doesn’t matter if you’re going through pregnancy as you’ve always imagined. Let go of idealistic fantasies and do what you can in your current circumstances.

Before planning your pregnancy you might want to get your symptoms in check and figure out your disease patterns, so you can make the experience easier on yourself. Looking for treatments under investigation can be a good idea for you or you might want to explore alternative therapies to supplement your current treatment. Whatever path you choose, remember that clinical trials are always looking for better ways to manage MG symptoms and by the time you start planning your family, you might have more options than you anticipated.