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Longitudinal dispensing records of symptomatic MG medications, oral corticosteroids (OCS), and non-steroidal immunosuppressant therapy (NSIST) were extracted from prescription registers, which were individually linked to hospital records in the national patient registers and demographic and clinical data in the medical birth registers. Group-based multi-trajectory modeling (GBMTM) was used to identify pregnancy clusters and typical mono- or polytherapy medication use trajectories until delivery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 339 MG pregnancies, 201 (59%) used some MG medication during pregnancy or 1\u00a0year before. Four distinct multi-drug trajectories were identified: \u2018Intermittent users,\u2019 \u2018Persistent symptomatic-only users,\u2019 \u2018Immunosuppressant plus symptomatic users,\u2019 and \u2018Immunosuppressant-only users.\u2019 Most symptomatic medication users remained on a stable medication use trajectory during pregnancy. Increased use of OCS was overall rare, but occurred in around 10% of \u201cIntermittent users\u201d. \u2018Immunosuppressant-only users\u2019 had stable OCS use throughout the study period and frequent non-MG hospital contacts, but rarely contacts due to MG. Although MG-related admissions were infrequent overall, they were consistently higher among \u2018Immunosuppressant plus symptomatic users\u2019. Further, \u2018Immunosuppressant plus symptomatic users\u2019 often discontinued NSIST during pregnancy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interpretation<\/jats:title>\n                    <jats:p>Most patients had no, low, or stable medication use throughout pre-pregnancy and pregnancy. Medication use trajectories discriminated MG patients with similar phenotypes and distinct healthcare utilization patterns. Such subgroups likely represent distinct disease courses in relation to pregnancy which could help in the development of individualized care pathways.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00415-026-14115-2","type":"journal-article","created":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T17:33:51Z","timestamp":1788802431000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Medication use trajectories in myasthenia gravis pregnancies: a population-based drug utilization study"],"prefix":"10.1007","volume":"273","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-2550-2256","authenticated-orcid":false,"given":"Jenny Linnea Victoria","family":"Lindroos","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nils Erik","family":"Gilhus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susanna","family":"Brauner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marte-Helene","family":"Bj\u00f8rk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jana","family":"Midelfart-Hoff","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolyn E.","family":"Cesta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kari","family":"Furu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqueline M.","family":"Cohen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,7]]},"reference":[{"issue":"8","key":"14115_CR1","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. 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N.E.G. has received financial support from Grifols, UCB Pharma, Argenx, Janssen, Johnson&Johnson, Merck, Roche, Alexion, Immunovant, Huma, Denka, Amgen, NMD Pharma, Novartis, Lundbeck, Regeneron, Medison, and Dianthus. S.B. has received research grants from UCB Pharma and Janssen, unrelated to the current project. M-H.B. has received speaker honoraria and\/or consultancy honoraria from Teva, Eisai, AbbVie, Pfizer, Novartis, Lundbeck, Angelini Pharma, Organon, Jazz pharmaceuticals, and Lilly, none in relation to the topic in the paper. J.M.H. reports no disclosures relevant to the manuscript. C.E.C., K.F. and J.M.C. report participation in research projects funded by pharmaceutical companies mandated by regulatory authorities, all with funds paid to their institution (no personal fees) and with no relation to the work reported in this paper. Non-financial interests: None.","order":1,"name":"Ethics","label":"Conflicts of interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Data were collected and handled in accordance with the Declaration of Helsinki and with approvals from ethics review boards in Norway (REK s\u00f8r-\u00f8st [2017\/2546]) and Sweden (the Stockholm Regional Ethical Review Board [Dnr 2015\/1826-31\/2] and the Swedish Ethical Review Authority [2023-01622-02]), which waived the requirement for individual patient consent.","order":2,"name":"Ethics","label":"Ethics approval and patient consent","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"572"}}