{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T02:44:28Z","timestamp":1782701068508,"version":"3.54.5"},"reference-count":53,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T00:00:00Z","timestamp":1782432000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: To summarize current evidence regarding the pathophysiology, clinical management, and maternal and neonatal outcomes associated with pregnancy in women with myasthenia gravis (MG). Materials and Methods: This structured narrative review was based on literature searches conducted in major biomedical databases, including PubMed\/MEDLINE, Scopus, Web of Science, and the Cochrane Library. Eligible publications included observational studies, cohort studies, case series, and clinically relevant case reports addressing MG management during pregnancy and postpartum. Due to heterogeneity in study design, patient populations, interventions, and reported outcomes, findings were synthesized narratively rather than quantitatively. Results: The available evidence suggests that pregnancy outcomes in women with MG are generally favorable when multidisciplinary monitoring and individualized treatment strategies are applied. Disease exacerbations may occur during pregnancy or the postpartum period, particularly in women with generalized MG or respiratory involvement. Observational evidence indicates that prior thymectomy may be associated with reduced rates of MG exacerbation and transient neonatal myasthenia gravis (TNMG), although available data remain limited. Careful selection of pharmacological therapy, prenatal monitoring, anesthetic management, and postpartum surveillance is essential to optimize maternal and neonatal outcomes. Conclusions: Myasthenia gravis is generally compatible with successful pregnancy outcomes; however, affected women may require closer monitoring because of the potential risk of disease exacerbation, myasthenic crisis, and neonatal complications. Management should be individualized and supported by multidisciplinary collaboration involving neurologists, obstetricians, anesthesiologists, and neonatologists.<\/jats:p>","DOI":"10.3390\/medicina62071238","type":"journal-article","created":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T00:54:42Z","timestamp":1782694482000},"page":"1238","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Myasthenia Gravis and Pregnancy: Clinical Management and Maternal\u2013Neonatal Outcomes"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-7643-5879","authenticated-orcid":false,"given":"Zlatko","family":"Kirovakov","sequence":"first","affiliation":[{"name":"Faculty for Public Health and Healthcare, Prof. Assen Zlatarov University, 8010 Burgas, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7719-382X","authenticated-orcid":false,"given":"Angel","family":"Yordanov","sequence":"additional","affiliation":[{"name":"Department of Gynecologic Oncology, Medical University Pleven, 5800 Pleven, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-7109-607X","authenticated-orcid":false,"given":"Vasilena","family":"Dimitrova","sequence":"additional","affiliation":[{"name":"Department of Gynecologic Oncology, Medical University Pleven, 5800 Pleven, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Cao, M., Koneczny, I., and Vincent, A. (2020). Myasthenia gravis with antibodies against muscle specific kinase: An update on clinical features, pathophysiology and treatment. Front. Mol. Neurosci., 13.","DOI":"10.3389\/fnmol.2020.00159"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Dresser, L., Wlodarski, R., Rezania, K., and Soliven, B. (2021). Myasthenia gravis: Epidemiology, pathophysiology and clinical manifestations. JCM, 10.","DOI":"10.3390\/jcm10112235"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Dziadkowiak, E., Baczy\u0144ska, D., and Waliszewska-Pros\u00f3\u0142, M. (2024). Musk myasthenia gravis\u2014Potential pathomechanisms and treatment directed against specific targets. Cells, 13.","DOI":"10.3390\/cells13060556"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"110826","DOI":"10.1016\/j.clinbiochem.2024.110826","article-title":"The changing landscape of autoantibody testing in myasthenia gravis in the setting of novel drug treatments","volume":"133\u2013134","author":"Mousavi","year":"2024","journal-title":"Clin. Biochem."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1186\/s42466-021-00122-3","article-title":"Diagnosis and treatment of neurogenic dysphagia\u2014S1 guideline of the German Society of Neurology","volume":"3","author":"Dziewas","year":"2021","journal-title":"Neurol. Res. Pract."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Gilhus, N.E. (2020). Myasthenia gravis can have consequences for pregnancy and the developing child. Front. Neurol., 11.","DOI":"10.3389\/fneur.2020.00554"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1186\/s12955-020-01549-z","article-title":"Gender differences in quality of life among patients with myasthenia gravis in China","volume":"18","author":"Dong","year":"2020","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e16100","DOI":"10.1111\/ene.16100","article-title":"Pregnancy outcomes for women with myasthenia gravis and their newborns: A nationwide register-based cohort study","volume":"31","author":"Brauner","year":"2024","journal-title":"Eur. J. Neurol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"bcr2014208323","DOI":"10.1136\/bcr-2014-208323","article-title":"New diagnosis myasthenia gravis and preeclampsia in late pregnancy","volume":"2015","author":"Ozcan","year":"2015","journal-title":"BMJ Case Rep."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1093","DOI":"10.1007\/s40120-025-00750-w","article-title":"Incidence and Prevalence of Juvenile Myasthenia Gravis in the United States Between 2010 and 2020: Analysis of Two Claims Databases","volume":"14","author":"Zhou","year":"2025","journal-title":"Neurol. Ther."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"302","DOI":"10.4103\/ijp.IJP_452_17","article-title":"Management of myasthenia gravis during pregnancy","volume":"50","author":"Bansal","year":"2018","journal-title":"Indian J. Pharmacol."},{"key":"ref_12","first-page":"e42772","article-title":"Choices and challenges with treatment of myasthenia gravis in pregnancy: A systematic review","volume":"15","author":"Kumar","year":"2023","journal-title":"Cureus"},{"key":"ref_13","first-page":"767","article-title":"Myasthenia gravis and pregnancy: Toronto specialty center experience","volume":"48","author":"Alharbi","year":"2021","journal-title":"Can. J. Neurol. Sci."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2050313X241253998","DOI":"10.1177\/2050313X241253998","article-title":"Myasthenia gravis and pregnancy: Lessons learned from a complex case report","volume":"12","author":"Benlghazi","year":"2024","journal-title":"SAGE Open Med. Case Rep."},{"key":"ref_15","first-page":"e86517","article-title":"Challenges of a pregnant woman with untreated myasthenia gravis: Delivery and puerperium","volume":"17","author":"Plancha","year":"2025","journal-title":"Cureus"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2139","DOI":"10.1212\/WNL.0000000000003339","article-title":"Increased risk for clinical onset of myasthenia gravis during the postpartum period","volume":"87","author":"Boldingh","year":"2016","journal-title":"Neurology"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Blagova, O., Rud\u2019, R., Kogan, E., Zaitsev, A., and Nedostup, A. (2023). Comparative efficacy and safety of mycophenolate mofetil and azathioprine in combination with corticosteroids in the treatment of lymphocytic myocarditis. JCM, 12.","DOI":"10.3390\/jcm12154913"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1912","DOI":"10.18203\/2320-1770.ijrcog20241801","article-title":"Myasthenia gravis in pregnancy: A rare disorder with multidisciplinary management","volume":"13","author":"Varun","year":"2024","journal-title":"Int. J. Reprod. Contracept. Obstet. Gynecol."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Velikova, T., Sekulovski, M., Bogdanova, S., Vasilev, G., Peshevska-Sekulovska, M., Miteva, D., and Georgiev, T. (2023). Intravenous immunoglobulins as immunomodulators in autoimmune diseases and reproductive medicine. Antibodies, 12.","DOI":"10.3390\/antib12010020"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"102473","DOI":"10.1016\/j.bpobgyn.2024.102473","article-title":"Preventing maternal morbidity and mortality from preeclampsia and eclampsia particularly in low- and middle-income countries","volume":"94","author":"Ngene","year":"2024","journal-title":"Best Pract. Res. Clin. Obstet. Gynaecol."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Gaudernack, L.C., Michelsen, T.M., Egeland, T., Voldner, N., and Lukasse, M. (2020). Does prolonged labor affect the birth experience and subsequent wish for cesarean section among first-time mothers? A quantitative and qualitative analysis of a survey from Norway. BMC Pregnancy Childbirth, 20.","DOI":"10.1186\/s12884-020-03196-0"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"414","DOI":"10.1016\/j.bjae.2021.07.001","article-title":"Perioperative management of myasthenia gravis","volume":"21","author":"Daum","year":"2021","journal-title":"BJA Educ."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e258964582207130","DOI":"10.2174\/25896458-v16-e2207130","article-title":"Physiological changes in the pregnancy and anesthetic implication during labor, delivery, and postpartum","volume":"16","author":"Melaku","year":"2022","journal-title":"TOATJ"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Monanian, G., Greenspan, S., Khan Yusufzai, N., Daoud, B., Jin, Z., and Factor, M. (2025). Anesthetic management of the pregnant patient undergoing non-obstetric surgery. Medicina, 61.","DOI":"10.3390\/medicina61040698"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1","DOI":"10.5317\/wjog.v9.i1.1","article-title":"Myasthenia gravis and pregnancy","volume":"9","author":"Je","year":"2020","journal-title":"WJOG"},{"key":"ref_26","first-page":"e41381","article-title":"Postpartum depression and maternal care: Exploring the complex effects on mothers and infants","volume":"15","author":"Saharoy","year":"2023","journal-title":"Cureus"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Lindroos, J.L.V., Bj\u00f8rk, M.H., and Gilhus, N.E. (2024). Transient neonatal myasthenia gravis as a common complication of a rare disease: A systematic review. JCM, 13.","DOI":"10.3390\/jcm13041136"},{"key":"ref_28","first-page":"15","article-title":"Transient neonatal myasthenia gravis born to a mother with asymptomatic mg: A case report","volume":"14","author":"Yang","year":"2024","journal-title":"Degener. Neurol. Neuromuscul. Dis."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Page, M.J., McKenzie, J.E., Bossuyt, P.M., Boutron, I., Hoffmann, T.C., Mulrow, C.D., Shamseer, L., Tetzlaff, J.M., Akl, E.A., and Brennan, S.E. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372.","DOI":"10.1136\/bmj.n71"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1007\/s00404-024-07436-y","article-title":"Pregnancy in myasthenia gravis: A retrospective analysis of maternal and neonatal outcome from a large tertiary care center in Germany","volume":"310","author":"Draxler","year":"2023","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_31","first-page":"461","article-title":"Myasthenia gravis and preeclampsia: Dot all the I\u2019s and cross all the T\u2019s","volume":"12","author":"Hassan","year":"2017","journal-title":"J. Taibah Univ. Med. Sci."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"8308","DOI":"10.1080\/14767058.2021.1973418","article-title":"Myasthenia gravis and covid-19 in pregnancy: A review of the literature and case series report","volume":"35","author":"Neykova","year":"2022","journal-title":"J. Matern. Fetal Neonatal Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"S593","DOI":"10.1016\/j.jval.2024.10.3663","article-title":"RWD105 Dosing Schedules and Concomitant Medication Usage in Patients With Generalized Myasthenia Gravis Treated With Ravulizumab or Efgartigimod","volume":"27","author":"Silvestri","year":"2024","journal-title":"Value Health"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1","DOI":"10.17077\/2154-4751.1391","article-title":"Combination of myasthenia gravis and HELLP Syndrome in pregnancy: Case report and literature review","volume":"8","author":"Bahat","year":"2018","journal-title":"Proc. Obstet. Gynecol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e16229","DOI":"10.1111\/ene.16229","article-title":"Generalized myasthenia gravis with acetylcholine receptor antibodies: A guidance for treatment","volume":"31","author":"Gilhus","year":"2024","journal-title":"Euro J. Neurol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"412","DOI":"10.3988\/jcn.2023.0285","article-title":"Clinical Characteristics and Outcomes of Generalized Myasthenia Gravis in Malaysia: A Single-Center Experience","volume":"20","author":"Tan","year":"2024","journal-title":"J. Clin. Neurol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"3329","DOI":"10.1007\/s00415-023-11733-y","article-title":"Myasthenia gravis, respiratory function, and respiratory tract disease","volume":"270","author":"Gilhus","year":"2023","journal-title":"J. Neurol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1007\/s13311-022-01181-3","article-title":"Antibody therapies in autoimmune neuromuscular junction disorders: Approach to myasthenic crisis and chronic management","volume":"19","author":"Vanoli","year":"2022","journal-title":"Neurotherapeutics"},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Zheng, Y.-L., Su, G.-Z., Li, Y.-L., Du, T., Zhao, X.-L., Wang, C.-C., Liu, Y., Liu, B., Duan, R.-S., and Li, X.-L. (2025). Myasthenia gravis with double-seropositive acetylcholine receptor and low-density lipoprotein receptor-related protein 4 antibodies combined with muscle atrophy: A case report and literature review. Front. Immunol., 16.","DOI":"10.3389\/fimmu.2025.1545579"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Petchesi, C.D., Jurca, A.A., Jurca, A.D., Dorobantu, F.R., Iuhas, A.R., Severin, E., and Jurca, C.M. (2025). Congenital Myasthenic Syndrome-4C in a Consanguineous Romani Family: Genetic Insights and Clinical Implications. Diagnostics, 15.","DOI":"10.3390\/diagnostics15030235"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Spendiff, S., Lochm\u00fcller, H., and Maselli, R.A. (2025). Congenital myasthenic syndromes. International Review of Neurobiology, Elsevier.","DOI":"10.1016\/bs.irn.2025.04.025"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1097\/JXX.0000000000000878","article-title":"Congenital myasthenic syndrome due to a genetic mutation","volume":"35","author":"Levkova","year":"2023","journal-title":"J. Am. Assoc. Nurse Pract."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"97","DOI":"10.4103\/sjmms.sjmms_80_22","article-title":"Thymectomy in Myasthenia Gravis: A Narrative Review","volume":"10","author":"Aljaafari","year":"2022","journal-title":"Saudi J. Med. Med. Sci."},{"key":"ref_44","first-page":"e37584","article-title":"Effect of Thymectomy on Outcomes of Myasthenia Gravis Patients: A Case-Control Study at a Tertiary Care Hospital","volume":"15","author":"Khawaja","year":"2023","journal-title":"Cureus"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"17","DOI":"10.21037\/med-25-12","article-title":"Thymic hyperplasia in myasthenia gravis: A narrative review","volume":"9","author":"Sikorski","year":"2025","journal-title":"Mediastinum"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"640","DOI":"10.1002\/pmrj.12976","article-title":"Multidisciplinary collaborative consensus guidance statement on the assessment and treatment of neurologic sequelae in patients with post-acute sequelae of SARS-CoV -2 infection (PASC)","volume":"15","author":"Melamed","year":"2023","journal-title":"PM&R"},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Ignatova, V., Kostadinov, K., Vassileva, E., Muradyan, N., Stefanov, G., Iskrov, G., and Stefanov, R. (2022). Socio-Economic Burden of Myasthenia Gravis: A Cost-of-Illness Study in Bulgaria. Front. Public Health, 10.","DOI":"10.3389\/fpubh.2022.822909"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1186\/s12967-023-04421-y","article-title":"Peripheral immune landscape for hypercytokinemia in myasthenic crisis utilizing single-cell transcriptomics","volume":"21","author":"Zhong","year":"2023","journal-title":"J. Transl. Med."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1186\/s13023-020-01670-8","article-title":"Survey on patients\u2019 organisations\u2019 knowledge and position paper on screening for inherited neuromuscular diseases in Europe","volume":"16","author":"Lamy","year":"2021","journal-title":"Orphanet J. Rare Dis."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Lazaridis, K., and Tzartos, S.J. (2020). Autoantibody Specificities in Myasthenia Gravis; Implications for Improved Diagnostics and Therapeutics. Front. Immunol., 11.","DOI":"10.3389\/fimmu.2020.00212"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"175","DOI":"10.32598\/bcn.2023.4360.5","article-title":"Myasthenia Gravis and COVID-19: A Systematic Review and Meta-analysis","volume":"15","author":"Nafari","year":"2024","journal-title":"Basic Clin. Neurosci."},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Dzhambazova, E., Kostadinov, K., Tsenkova-Toncheva, L., Galabova, F., Ezeldin, F., Iskrov, G., and Stefanov, R. (2025). The Socio-Economic Burden of Spinal Muscular Atrophy: A Cost-of-Illness Study in Bulgaria. Healthcare, 13.","DOI":"10.3390\/healthcare13040401"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"408","DOI":"10.3897\/folmed.62.e48580","article-title":"Autoimmune Polyglandular Syndrome Type 2 and Pregnancy","volume":"62","author":"Yanachkova","year":"2020","journal-title":"Folia Medica"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/7\/1238\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T01:50:27Z","timestamp":1782697827000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/7\/1238"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,26]]},"references-count":53,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["medicina62071238"],"URL":"https:\/\/doi.org\/10.3390\/medicina62071238","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,26]]}}}