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Wednesday, April 23, 2014
Abortion (miscarriage) in myasthenia gravis
I am emailing from Pakistan. I am a pediatrician and one of my relatives has myasthenia gravis. She aborted (miscarried) once and now has become pregnant again. She again complains of vague symptoms of lower abdominal pain as the first time. She is very worried that she might abort (miscarry) again. She also has had tymectomy done for many years. Can you advise me any further about the indicence of abortion and how common it is in this disease. Suggest any treatments that can help her.
I am not aware of any direct connection between myasthenia and miscarriages. It is not a common complication of the disease. Myasthenia is a disease of the connection between skeletal muscle and nerve, so I am not sure how it could cause problems with the smooth muscle of the uterus. If she is taking medications like pyridostigmine (Mestinon, Gravitor), then there is a theoretical risk of premature uterine contractions. There is also the chance that there is another autoimmune process, as patients with one autoimmune disease have a higher incidence of a second autoimmune disease (like a thrombophilic disorder). Neonatal myasthenia can affect 10-20% of newborns, but this usually manifests as poor feeding, generalized weakness, and poor tone for the newborn for a short period after birth. Myasthenia can exacerbate during pregnancy, but again, I am not sure how this would cause miscarriage.
I hope this helps.
Robert W Neel, IV, MD
Assistant Professor of Neurology
College of Medicine
University of Cincinnati