{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T22:04:27Z","timestamp":1790805867697,"version":"4.1.0"},"reference-count":39,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T00:00:00Z","timestamp":1772668800000},"content-version":"vor","delay-in-days":4,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universit\u00e4tsklinikum Hamburg-Eppendorf (UKE)"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Neurol"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Myasthenia gravis (MG) is an autoimmune disease with an onset age distribution in women, which peaks within the reproductive age range, leading to a potential interference with pregnancy. In this systematic review, we aim to assess the impact of pregnancy on the course of MG during pregnancy and postpartum period and to identify potential risk factors influencing the postpartum course.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic literature search was conducted in the two databases PubMed and Epistemonikos on the topic \u201cMyasthenia gravis and pregnancy\u201d in October 2025. We included cohort studies and case series with at least 5 cases, reporting the clinical course of MG in women during pregnancy or postpartum period. Quality assessment was performed using the Critical Appraisal Skills Programme (CASP) tool for cohort studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In total, 34 studies were included, covering 3720 pregnancies in women with MG. Of 842 pregnancies worsening myasthenic symptoms was reported in 30% of pregnancies most frequently in the first trimester. Postpartum exacerbations were observed in 27% of the cases. However, incidence of worsening and scoring systems differed vastly. Preterm birth was reported at a rate of 9%. Vaginal delivery and cesarean section were performed in 68% and 32% respectively. Of 1530 infants, 9% developed neonatal myasthenia gravis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This review confirms that symptom worsening is most common in the first trimester or postpartum. Women with MG were more likely to require cesarean section or operative vaginal delivery compared to general population data. However, the studies\u2019 quality varied widely. Prospective studies are needed to better identify risk factors for complicative course during pregnancy and postpartum period.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00415-026-13724-1","type":"journal-article","created":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T17:09:30Z","timestamp":1772730570000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Myasthenia gravis and pregnancy: a systematic review and meta-analysis"],"prefix":"10.1007","volume":"273","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-5673-6979","authenticated-orcid":false,"given":"Lisa","family":"Miegel","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0654-9972","authenticated-orcid":false,"given":"Julia","family":"Hickstein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-9442-2886","authenticated-orcid":false,"given":"Antonia","family":"Reibelt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8131-9467","authenticated-orcid":false,"given":"Christoph","family":"Heesen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2967-4290","authenticated-orcid":false,"given":"Charlotte","family":"Schubert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,5]]},"reference":[{"key":"13724_CR1","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1177\/1753495X211041899","volume":"15","author":"H Banner","year":"2022","unstructured":"Banner H, Niles KM, Ryu M, Sermer M, Bril V, Murphy KE (2022) Myasthenia gravis in pregnancy: systematic review and case series. Obstet Med 15:108\u2013117","journal-title":"Obstet Med"},{"key":"13724_CR2","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1002\/mus.20950","volume":"37","author":"D Grob","year":"2008","unstructured":"Grob D, Brunner N, Namba T, Pagala M (2008) Lifetime course of myasthenia gravis. Muscle Nerve 37:141\u2013149","journal-title":"Muscle Nerve"},{"key":"13724_CR3","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1186\/s13023-022-02205-z","volume":"17","author":"M Su","year":"2022","unstructured":"Su M, Liu X, Wang L et al (2022) Risk factors for pregnancy-related clinical outcome in myasthenia gravis: a systemic review and meta-analysis. Orphanet J Rare Dis 17:52","journal-title":"Orphanet J Rare Dis"},{"key":"13724_CR4","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1111\/ene.14057","volume":"27","author":"A Bogdan","year":"2020","unstructured":"Bogdan A, Barnett C, Ali A et al (2020) Chronic stress, depression and personality type in patients with myasthenia gravis. Eur J Neurol 27:204\u2013209","journal-title":"Eur J Neurol"},{"key":"13724_CR5","doi-asserted-by":"publisher","first-page":"118","DOI":"10.1016\/j.jns.2017.10.037","volume":"383","author":"J Gamez","year":"2017","unstructured":"Gamez J, Salvado M, Casellas M, Manrique S, Castillo F (2017) Intravenous immunoglobulin as monotherapy for myasthenia gravis during pregnancy. J Neurol Sci 383:118\u2013122","journal-title":"J Neurol Sci"},{"key":"13724_CR6","doi-asserted-by":"publisher","first-page":"715","DOI":"10.1002\/mus.25095","volume":"54","author":"AC Braga","year":"2016","unstructured":"Braga AC, Pinto C, Santos E, Braga J (2016) Myasthenia gravis in pregnancy: experience of a portuguese center. Muscle Nerve 54:715\u2013720","journal-title":"Muscle Nerve"},{"key":"13724_CR7","doi-asserted-by":"publisher","first-page":"328","DOI":"10.1097\/00006250-198309000-00013","volume":"62","author":"RD Eden","year":"1983","unstructured":"Eden RD, Gall SA (1983) Myasthenia gravis and pregnancy: a reappraisal of thymectomy. Obstet Gynecol 62:328\u2013333","journal-title":"Obstet Gynecol"},{"key":"13724_CR8","doi-asserted-by":"publisher","first-page":"718","DOI":"10.1136\/jnnp-2022-330533","volume":"94","author":"C Schubert","year":"2023","unstructured":"Schubert C, Steinberg L, Peper J et al (2023) Postpartum relapse risk in multiple sclerosis: a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry 94:718\u2013725","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"13724_CR9","doi-asserted-by":"publisher","first-page":"2139","DOI":"10.1212\/WNL.0000000000003339","volume":"87","author":"MI Boldingh","year":"2016","unstructured":"Boldingh MI, Maniaol AH, Brunborg C, Weedon-Fekj\u00e6r H, Verschuuren JJ, Tallaksen CM (2016) Increased risk for clinical onset of myasthenia gravis during the postpartum period. Neurology 87:2139\u20132145","journal-title":"Neurology"},{"key":"13724_CR10","doi-asserted-by":"publisher","first-page":"210","DOI":"10.1186\/s13643-016-0384-4","volume":"5","author":"M Ouzzani","year":"2016","unstructured":"Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A (2016) Rayyan\u2014a web and mobile app for systematic reviews. Syst Rev 5:210","journal-title":"Syst Rev"},{"key":"13724_CR11","doi-asserted-by":"publisher","first-page":"889","DOI":"10.1111\/j.1468-1331.2009.02689.x","volume":"16","author":"JC Wen","year":"2009","unstructured":"Wen JC, Liu TC, Chen YH, Chen SF, Lin HC, Tsai WC (2009) No increased risk of adverse pregnancy outcomes for women with myasthenia gravis: a nationwide population-based study. Eur J Neurol 16:889\u2013894","journal-title":"Eur J Neurol"},{"key":"13724_CR12","doi-asserted-by":"publisher","first-page":"231","DOI":"10.1016\/j.ejcts.2005.11.022","volume":"29","author":"TC Roth","year":"2006","unstructured":"Roth TC, Raths J, Carboni G, R\u00f6sler K, Schmid RA (2006) Effect of pregnancy and birth on the course of myasthenia gravis before or after transsternal radical thymectomy. Eur J Cardiothorac Surg 29:231\u2013235","journal-title":"Eur J Cardiothorac Surg"},{"key":"13724_CR13","doi-asserted-by":"publisher","first-page":"985","DOI":"10.1097\/EJA.0b013e32833e263f","volume":"27","author":"C Almeida","year":"2010","unstructured":"Almeida C, Coutinho E, Moreira D, Santos E, Aguiar J (2010) Myasthenia gravis and pregnancy: anaesthetic management\u2014a series of cases. Eur J Anaesthesiol 27:985\u2013990","journal-title":"Eur J Anaesthesiol"},{"key":"13724_CR14","doi-asserted-by":"publisher","first-page":"267","DOI":"10.1016\/0020-7292(81)90073-4","volume":"19","author":"OF Giwa-Osagie","year":"1981","unstructured":"Giwa-Osagie OF, Newton JR, Larcher V (1981) Obstetric performance of patients with my asthenia gravis. Int J Gynaecol Obstet 19:267\u2013270","journal-title":"Int J Gynaecol Obstet"},{"key":"13724_CR15","first-page":"603","volume":"26","author":"L Podciechowski","year":"2005","unstructured":"Podciechowski L, Brocka-Nitecka U, Dabrowska K, Bielak A, Hadacz B, Wilczynski J (2005) Pregnancy complicated by myasthenia gravis\u2014twelve years experience. Neuro Endocrinol Lett 26:603\u2013608","journal-title":"Neuro Endocrinol Lett"},{"key":"13724_CR16","doi-asserted-by":"publisher","first-page":"447","DOI":"10.1212\/WNL.52.3.447","volume":"52","author":"AP Batocchi","year":"1999","unstructured":"Batocchi AP, Majolini L, Evoli A, Lino MM, Minisci C, Tonali P (1999) Course and treatment of myasthenia gravis during pregnancy. Neurology 52:447\u2013452","journal-title":"Neurology"},{"key":"13724_CR17","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1016\/S0301-2115(02)00051-9","volume":"104","author":"J Djelmis","year":"2002","unstructured":"Djelmis J, Sostarko M, Mayer D, Ivanisevic M (2002) Myasthenia gravis in pregnancy: report on 69 cases. Eur J Obstet Gynecol Reprod Biol 104:21\u201325","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"13724_CR18","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1002\/mus.27839","volume":"68","author":"Y Harada","year":"2023","unstructured":"Harada Y, Bettin M, Juel VC et al (2023) Pregnancy in MuSK-positive myasthenia gravis: a single-center case series. Muscle Nerve 68:85\u201390","journal-title":"Muscle Nerve"},{"key":"13724_CR19","doi-asserted-by":"publisher","first-page":"352","DOI":"10.1016\/j.nmd.2017.01.021","volume":"27","author":"RD Ducci","year":"2017","unstructured":"Ducci RD, Lorenzoni PJ, Kay CS, Werneck LC, Scola RH (2017) Clinical follow-up of pregnancy in myasthenia gravis patients. Neuromuscul Disord 27:352\u2013357","journal-title":"Neuromuscul Disord"},{"key":"13724_CR20","first-page":"e13641","volume":"88","author":"Q Zhou","year":"2022","unstructured":"Zhou Q, Yin W, Zhu J et al (2022) Risk factors associated with adverse pregnancy outcomes and postpartum exacerbation in women with myasthenia gravis. Am J Reprod Immunol (New York NY 1989) 88:e13641","journal-title":"Am J Reprod Immunol (New York NY 1989)"},{"key":"13724_CR21","doi-asserted-by":"publisher","first-page":"318","DOI":"10.1002\/mus.28021","volume":"69","author":"S Anabusi","year":"2024","unstructured":"Anabusi S, Izenberg A, Barnett C, Berndl A (2024) Pregnancy planning may impact maternal and neonatal outcomes in people with myasthenia gravis. Muscle Nerve 69:318\u2013324","journal-title":"Muscle Nerve"},{"key":"13724_CR22","first-page":"767","volume":"48","author":"M Alharbi","year":"2021","unstructured":"Alharbi M, Menon D, Barnett C, Katzberg H, Sermer M, Bril V (2021) Myasthenia gravis and pregnancy: Toronto Specialty Center experience. Can J Neurol Sci 48:767\u2013771","journal-title":"Can J Neurol Sci"},{"key":"13724_CR23","doi-asserted-by":"publisher","first-page":"452","DOI":"10.1186\/s13023-024-03466-6","volume":"19","author":"M Su","year":"2024","unstructured":"Su M, Liu X, Wu Z et al (2024) Nomogram for predicting pregnancy-related relapse of myasthenia gravis. Orphanet J Rare Dis 19:452","journal-title":"Orphanet J Rare Dis"},{"key":"13724_CR24","doi-asserted-by":"publisher","first-page":"686","DOI":"10.5603\/gpl.102412","volume":"96","author":"S Aksam","year":"2025","unstructured":"Aksam S, Kocijancic Belojevic D, Dotlic J et al (2025) Pregnancy and neonatal outcomes in women with myasthenia gravis: two decades experience from a university clinic. Ginekol Pol 96:686\u2013693","journal-title":"Ginekol Pol"},{"key":"13724_CR25","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1212\/WNL.55.1.16","volume":"55","author":"A Jaretzki 3rd","year":"2000","unstructured":"Jaretzki A 3rd, Barohn RJ, Ernstoff RM et al (2000) Myasthenia gravis: recommendations for clinical research standards. Task Force of the Medical Scientific Advisory Board of the Myasthenia Gravis Foundation of America. Neurology 55:16\u201323","journal-title":"Neurology"},{"key":"13724_CR26","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1001\/archinte.1958.00260190074008","volume":"102","author":"KE Osserman","year":"1958","unstructured":"Osserman KE, Kornfeld P, Cohen E (1958) Studies in myasthenia gravis; review of two hundred eighty-two cases at the Mount Sinai Hospital, New York City. AMA Arch Intern Med 102:72\u201381","journal-title":"AMA Arch Intern Med"},{"key":"13724_CR27","doi-asserted-by":"publisher","first-page":"175628642312132","DOI":"10.1177\/17562864231213240","volume":"16","author":"H Wiendl","year":"2023","unstructured":"Wiendl H, Abicht A, Chan A et al (2023) Guideline for the management of myasthenic syndromes. Ther Adv Neurol Disord 16:17562864231213240","journal-title":"Ther Adv Neurol Disord"},{"key":"13724_CR28","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1212\/01.CON.0000443840.33310.bd","volume":"20","author":"JM Massey","year":"2014","unstructured":"Massey JM, De Jesus-Acosta C (2014) Pregnancy and myasthenia gravis. Continuum (Minneap Minn) 20:115\u2013127","journal-title":"Continuum (Minneap Minn)"},{"key":"13724_CR29","doi-asserted-by":"publisher","first-page":"372","DOI":"10.1097\/GRF.0b013e31828e92c0","volume":"56","author":"M Varner","year":"2013","unstructured":"Varner M (2013) Myasthenia gravis and pregnancy. Clin Obstet Gynecol 56:372\u2013381","journal-title":"Clin Obstet Gynecol"},{"key":"13724_CR30","doi-asserted-by":"publisher","first-page":"1362","DOI":"10.1212\/01.WNL.0000082725.21444.EC","volume":"61","author":"JM Hoff","year":"2003","unstructured":"Hoff JM, Daltveit AK, Gilhus NE (2003) Myasthenia gravis: consequences for pregnancy, delivery, and the newborn. Neurology 61:1362\u20131366","journal-title":"Neurology"},{"key":"13724_CR31","doi-asserted-by":"publisher","first-page":"e214139","DOI":"10.1212\/WNL.0000000000214139","volume":"105","author":"JLV Lindroos","year":"2025","unstructured":"Lindroos JLV, Bjork MH, Cohen JM et al (2025) Obstetric and neonatal outcomes in patients with maternal myasthenia gravis: a nationwide cohort study. Neurology 105:e214139","journal-title":"Neurology"},{"key":"13724_CR32","doi-asserted-by":"publisher","first-page":"1341","DOI":"10.1016\/S0140-6736(18)31928-7","volume":"392","author":"T Boerma","year":"2018","unstructured":"Boerma T, Ronsmans C, Melesse DY et al (2018) Global epidemiology of use of and disparities in caesarean sections. Lancet 392:1341\u20131348","journal-title":"Lancet"},{"key":"13724_CR33","doi-asserted-by":"publisher","first-page":"e1274","DOI":"10.1002\/hsr2.1274","volume":"6","author":"CM Angolile","year":"2023","unstructured":"Angolile CM, Max BL, Mushemba J, Mashauri HL (2023) Global increased cesarean section rates and public health implications: a call to action. Health Sci Rep 6:e1274","journal-title":"Health Sci Rep"},{"key":"13724_CR34","unstructured":"Gerischer L, Meisel A (2024) Leitlinie f\u00fcr myasthene Syndrome (Myasthenia gravis, Lambert-Eaton-Myasthenie-Syndrom, Kongenitale myasthene Syndrome) f\u00fcr Patientinnen und Patienten. Deutsche Hirnstiftung (DHS), Deutsche Gesellschaft f\u00fcr Neurologie (DGN) und Deutsche Myasthenie Gesellschaft"},{"key":"13724_CR35","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1097\/GCO.0000000000000156","volume":"27","author":"M Delnord","year":"2015","unstructured":"Delnord M, Blondel B, Zeitlin J (2015) What contributes to disparities in the preterm birth rate in European countries? Curr Opin Obstet Gynecol 27:133\u2013142","journal-title":"Curr Opin Obstet Gynecol"},{"key":"13724_CR36","doi-asserted-by":"publisher","first-page":"1261","DOI":"10.1016\/S0140-6736(23)00878-4","volume":"402","author":"EO Ohuma","year":"2023","unstructured":"Ohuma EO, Moller AB, Bradley E et al (2023) National, regional, and global estimates of preterm birth in 2020, with trends from 2010: a systematic analysis. Lancet 402:1261\u20131271","journal-title":"Lancet"},{"key":"13724_CR37","doi-asserted-by":"publisher","first-page":"547","DOI":"10.1016\/S1701-2163(16)30711-3","volume":"27","author":"G Smith","year":"2005","unstructured":"Smith G, Rafuse C, Anand N et al (2005) Prevalence, management, and outcomes of preterm prelabour rupture of the membranes of women in Canada. J Obstet Gynaecol Can 27:547\u2013553","journal-title":"J Obstet Gynaecol Can"},{"key":"13724_CR38","doi-asserted-by":"publisher","first-page":"2279","DOI":"10.1038\/s41372-021-00970-6","volume":"41","author":"P Kochhar","year":"2021","unstructured":"Kochhar P, Schumacher R, Sarkar S (2021) Transient neonatal myasthenia gravis: refining risk estimate for infants born to women with myasthenia gravis. J Perinatol 41:2279\u20132283","journal-title":"J Perinatol"},{"key":"13724_CR39","doi-asserted-by":"publisher","first-page":"404","DOI":"10.1016\/0002-9378(64)90443-0","volume":"88","author":"WC Plauche","year":"1964","unstructured":"Plauche WC (1964) Myasthenia gravis in pregnancy. Am J Obstet Gynecol 88:404\u2013409","journal-title":"Am J Obstet Gynecol"}],"container-title":["Journal of Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00415-026-13724-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00415-026-13724-1","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00415-026-13724-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T09:09:37Z","timestamp":1774516177000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00415-026-13724-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3]]},"references-count":39,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,3]]}},"alternative-id":["13724"],"URL":"https:\/\/doi.org\/10.1007\/s00415-026-13724-1","relation":{},"ISSN":["0340-5354","1432-1459"],"issn-type":[{"value":"0340-5354","type":"print"},{"value":"1432-1459","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3]]},"assertion":[{"value":"29 December 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 February 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 February 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 March 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflicts of interest"}},{"value":"This systematic review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. As this study is based solely on previously published literature and does not involve any new studies with human participants or animals performed by any of the authors, ethical approval and informed consent were not required.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval and informed consent"}}],"article-number":"184"}}