# Myasthenia Gravis in Pregnancy: Prenatal and Postnatal Diagnostic Challenges—A Narrative Review

## TL;DR

This review discusses the challenges of diagnosing and managing myasthenia gravis during pregnancy and highlights the need for better biomarkers to understand and treat the condition.

## Contribution

The paper emphasizes the importance of immunological and genetic biomarkers in understanding MG and improving its management during pregnancy.

## Key findings

- MG during pregnancy is associated with potential risks like preterm birth and small-for-gestational-age babies.
- Certain immunosuppressive drugs are unsafe during pregnancy, while others like prednisolone are considered safe.
- Biomarker research and high-throughput methods are needed to better understand MG subgroups and treatment responses.

## Abstract

Myasthenia gravis (MG) is a prevalent autoimmune disorder affecting neuromuscular junctions, typically characterized by muscle weakness due to autoantibodies targeting acetylcholine receptors (AChR) or muscle-specific kinase (MuSK). Generalized MG is a more severe form of the condition than ocular MG. Although MG can strike at any age, young adult women are typically affected, especially in their reproductive years. MG is rare during pregnancy, with the first trimester and the postpartum period being the most common times for exacerbations. The influence of MG on pregnancy outcomes remains ambiguous, with some studies finding larger prevalence of issues such as preterm birth and small-for-gestational-age babies, while others indicate results similar to the general population. Management of MG during pregnancy necessitates careful monitoring and drug adjustments. Teratogenic concerns make several immunosuppressive drugs, such mycophenolate mofetil and methotrexate, contraindicated. In contrast, medications like prednisolone and pyridostigmine are generally recognized as safe. Women with MG may have flare-ups after giving birth, and infants may have transient neonatal myasthenia gravis. Comprehensive prenatal treatment and multidisciplinary assistance are crucial for promoting maternal and fetal health during pregnancy in women with MG. This paper examines the relevance of immunological biomarkers, RNAs, and other novel biomarkers in myasthenia gravis (MG). It emphasizes the need for more investigation to determine their role in the pathogenesis of MG, evaluate biomarker profiles across subgroups, and look at changes after treatment. The study also underlines the significance of high-throughput investigations to detect new biomarkers and reveal genetic variables impacting MG pathogenesis.