A recently published study in Muscle & Nerve found that myasthenia gravis (MG) was associated with poor outcomes in pregnancy and the period immediately after; furthermore, MG-specific treatments varied during pregnancy. These findings suggest that more research on MG in pregnancy and treatment guidelines are needed.
The management of patients with MG during pregnancy is a complex process, given that both the disease and available treatments can have an adverse impact on the mother and child.
Existing studies paint a mixed picture with regards to MG and pregnancy outcomes. While some studies indicate that MG does not raise the risk of adverse pregnancy outcomes, others indicate otherwise.
Researchers sought to explore pregnancy outcomes among patients with MG, including after birth. They accessed the health insurance claims databases from three sources, encompassing both commercial insurance claims and state Medicaid claims.
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One of the sources for commercial insurance data was the Merative MarketScan Commercial Claims and Encounters (CCAE). This source contained 647 pregnancy cases from 2000 to 2023 that were continuously enrolled from preconception until postpartum, allowing for analysis on treatment patterns.
An analysis of pregnancies detailed in this database showed that patients with MG had a higher rate of preeclampsia (10.7% vs 7.1%) and Cesarean section (42.9% vs 36.7%) compared with age-adjusted individuals in the total population. The same was observed in preterm births (18.0% vs 9.9%) and infants that were small for gestational age (4.3% vs 1.7%). These findings were largely consistent in the other databases.
The research team found that changes in MG treatment were common among pregnant women with MG. “47% showed some change in treatment between preconception and pregnancy or between early and late pregnancy,” noted the study’s authors.
Approximately half (54.3%) of women were untreated during the six months prior to pregnancy, 61.2% were untreated during pregnancy and 57.8% were untreated during the six months following the end of the pregnancy. Among patients who were on acetylcholinesterase inhibitors during pregnancy, 21.8% did not take them before pregnancy; among those on steroids, 33.1% did not take them before pregnancy.
The authors noted that the data on outcomes and treatment warrant more research and guidelines on pregnancy and MG. “Results suggest a need for safe treatments in pregnancy and robust data showing their benefit–risk profile as well as improved treatment guidelines in this specific population,” they wrote. “Further research is needed to understand treatment and non-treatment-related predictors of pregnancy outcomes in MG.”
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