A new research paper published in The Lancet Neurology highlights how evolving treatments are reshaping pregnancy planning and care for people with myasthenia gravis (MG).
MG often begins in women during their childbearing years. Some individuals experience worsening symptoms during pregnancy, which can complicate delivery and lead to preventable maternal disability.
The authors report that keeping the disease well controlled before conception is one of the most important steps in improving outcomes. Women with stable symptoms going into pregnancy are less likely to experience severe flares, particularly those affecting breathing or swallowing muscles.
Close coordination between neurology and obstetric teams is recommended throughout pregnancy and delivery. “Involvement of a multidisciplinary team and fetal and infant monitoring are essential,” noted the study’s authors.
The paper also reviews both long-standing and newer MG treatments in the context of pregnancy. Certain older immunosuppressive medications, such as methotrexate and cyclophosphamide, are not considered safe because they carry known risks of birth defects or pregnancy loss and should be discontinued well before conception. Other therapies like tacrolimus or ciclosporin may be continued if the benefits of disease control outweigh potential risks to the fetus.
Learn more about MG treatment and care
Additionally, the researchers examine newer targeted treatments, including complement inhibitors and FcRn blockers, which are increasingly used for acetylcholine receptor–positive MG. Although pregnancy-specific data on these therapies is limited, the authors say early evidence from clinical use is generally reassuring. In some cases, stopping treatment may pose greater risks if it leads to a severe relapse.
The review notes that antibodies that cause MG can cross the placenta. Some newborns may develop temporary muscle weakness, known as neonatal myasthenia gravis, which usually resolves with treatment. Rarely, more serious complications can occur, making fetal monitoring an important part of care. Breastfeeding may be possible for individuals with MG, but decisions should be individualized and made jointly with a doctor.
Ultimately, the authors emphasize that individualized planning, disease stability and multidisciplinary care are central to helping women with MG navigate pregnancy safely.
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