Last update Aug. 18, 2019

Maternal Myasthenia Gravis

Compatible

Safe substance and/or breastfeeding is the best option.

There is no further risk of complications with myasthenia during lactation (Klehmet 2010), although the course of puerperium may be unpredictable and may worsen in case of infection or short-term disease (Djelmis 2002).

Breastfeeding is feasible and by no means contraindicated. In a series of 33 affected mothers with myasthenia, 76% successfully breastfed (Djelmis 2002); The mother should receive much support along with a effective control of her illness (Giwa-Osagie 1981, Camus 1989). Partial interrupted breastfeeding with formula supplementation may be required in those cases of extreme maternal fatigue (Djelmis 2002).
Most treatments for myasthenia gravis (see info on pyridostigmine, neostigmine, prednisone, cyclosporine, azathioprine, immunoglobulin, tacrolimus) are compatible while breastfeeding (Gilhus 2018, Skoglund 1978).

Approximately 10 - 30% of infants may show a transient neonatal myasthenia due to transplacental passage of acetylcholine anti-receptor antibodies (Gilhus 2018, Skoglund 1978); who should be treated and assisted since hypotonia interferes with a satisfactory feeding. There is a higher risk of transient neonatal myasthenia when the mother has not been thymectomized and with a short-term disease (Djelmis 2002, Roth 2006).
There is no conclusive evidence on the excretion in significant amounts of acetylcholine anti-receptor antibodies into breast milk (Djelmis 2002) and/or that it would be responsible for cases of transient neonatal myelitis (Brunner 1992).

An association between myasthenia and elevated prolactin levels has been found (Lysenko 1998, Tsinzerling 2006) and anecdotally reported with gigantomastia (Scarabin 2010)


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Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

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References

  1. Gilhus NE. Myasthenia Gravis Can Have Consequences for Pregnancy and the Developing Child. Front Neurol. 2020 Jun 12;11:554. Abstract
  2. Gilhus NE, Hong Y. Maternal myasthenia gravis represents a risk for the child through autoantibody transfer, immunosuppressive therapy and genetic influence. Eur J Neurol. 2018 Dec;25(12):1402-1409. Abstract
  3. Klehmet J, Dudenhausen J, Meisel A. [Course and treatment of myasthenia gravis during pregnancy]. Nervenarzt. 2010 Abstract
  4. Scarabin C, Koskas M, Bornes M, Azria E, Luton D. Gigantomastia and vulvar lactating adenoma in a patient with myasthenia during pregnancy. Am J Obstet Gynecol. 2010 Abstract
  5. Roth TC, Raths J, Carboni G, Rösler K, Schmid RA. Effect of pregnancy and birth on the course of myasthenia gravis before or after transsternal radical thymectomy. Eur J Cardiothorac Surg. 2006 Abstract
  6. Tsinzerling N, Pirskanen R, Matell G, Zhulev NM, Chukhlovina ML, Lefvert AK. Raised prolactin levels in myasthenia gravis: two case reports and a study of two patient populations. Acta Neurol Scand. 2006 Abstract
  7. Djelmis J, Sostarko M, Mayer D, Ivanisevic M. Myasthenia gravis in pregnancy: report on 69 cases. Eur J Obstet Gynecol Reprod Biol. 2002 Abstract
  8. Lysenko GI, Shevniuk MM, Shatrova KM, Pshenichnaia VA. [Hypophyseal-adreno-gonadal system function in myasthenia patients with tumorous and nontumorous pathology of the thymus]. Lik Sprava. 1998 Abstract
  9. Brenner T, Shahin R, Steiner I, Abramsky O. Presence of anti-acetylcholine receptor antibodies in human milk: possible correlation with neonatal myasthenia gravis. Autoimmunity. 1992 Abstract
  10. Camus M, Clouard C. [Myasthenia and pregnancy. Apropos of 8 cases]. J Gynecol Obstet Biol Reprod (Paris). 1989 Abstract
  11. Giwa-Osagie OF, Newton JR, Larcher V. Obstetric performance of patients with myasthenia gravis. Int J Gynaecol Obstet. 1981 Abstract
  12. Skoglund RR, Roberts CC, Huddlestone J. The role of anti-acetylcholine receptor antibody in neonatal myasthenia gravis. Bull Los Angeles Neurol Soc. 1978 Abstract
  13. Fraser D, Turner JW. Myasthenia Gravis and Pregnancy. Proc R Soc Med. 1963 Abstract Full text (link to original source)

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