Abstract:
Myasthenia gravis (MG) is an autoimmune disorder with bimodal age of presentation, occurring in young women of reproductive age and at an older age in men. Occasionally, MG is diagnosed during pregnancy. Management of MG includes symptomatic treatment with cholinesterase inhibitors and immunosuppressive therapy for controlling the disease activity. Treatment of MG in women of reproductive age, who may be contemplating pregnancy, requires discussion regarding the choice of medication as well as the understanding of risks/adverse effects involved with various treatments. During the peripartum period, it is essential to ensure careful monitoring of the disease state along with the well‐being of the mother and fetus and to coordinate neonatal monitoring overseen by a multidisciplinary team comprising a high‐risk maternal fetal medicine specialist, a neurologist familiar with these complex issues, and a neonatologist.
Objectives:1) To recognize the challenges and complex decision making in managing Myasthenia gravis patients contemplating pregnancy.
2) To be aware of the negative impact of medications on fertility and need to discontinue such medications when considering pregnancy.
3) To be able to select appropriate medications to minimize negative effect on the developing fetus.
4) To be aware of the potential complications during labor and delivery.
5) To realize the need for continued monitoring and a multi-disciplinary approach in managing patients with Myasthenia gravis.
ACCREDITATION STATEMENTThe AANEM is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
DISCLOSURE INFORMATION
Dr. Grover disclosed that she is a consultant for Soliris (Alexion Pharmaceutics), Inc. Dr. Sripathy had nothing to disclose. All conflicts of interest have been resolved according to ACCME standards. All authors/planners of this activity had nothing to disclose.
CREDIT DESIGNATION The AANEM designates this enduring material for a maximum of 2.0
AMA PRA Category 1 Credits TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Credit expires 011/20/2023.
Kavita M. Grover MBBS, MD, Naganand Sripathi, MBBS, MD