Myasthenia gravis and covid-19 in pregnancy: a review of the literature and case series report

Choices and Challenges With Treatment of Myasthenia Gravis in Pregnancy: A Systematic Review

Myasthenia gravis (MG) is an autoimmune disease affecting young women in their second and third decades, coinciding with their reproductive years. We aim to explore the choices and challenges in the treatment of MG in pregnancy. Cochrane, PubMed, Google Scholar, and Embase were the four databases systematically searched for studies with patients reporting pregnancy outcomes for women with MG during pregnancy using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) technique. Quality assessment was done using the Joanna Briggs Institute critical tool (JBI, Adelaide, Australia) for methodological quality. From 2000 to 2023, 40 studies from database search results were considered. There is a substantial risk of complications with MG, especially if it appears during pregnancy. In particular, widespread weakness is a cause of severe, life-threatening disorders, but several treatment options are available.

COVID-19 and myasthenia gravis: A review of neurological implications of the SARS-COV-2

INTRODUCTION

This review highlights the potential mechanisms of neuromuscular manifestation of COVID-19, especially myasthenia gravis (MG).

METHODS

An extensive literature search was conducted by two independent investigators using PubMed/MEDLINE and Google Scholar from its inception to December 2020.

RESULTS

Exacerbations of clinical symptoms in patients of MG who were treated with some commonly used COVID-19 drugs has been reported, with updated recommendations of management of symptoms of neuromuscular disorders. Severe acute respiratory syndrome coronavirus 2 can induce the immune response to trigger autoimmune neurological disorders.

CONCLUSIONS

Further clinical studies are warranted to indicate and rather confirm if MG in the setting of COVID-19 can pre-existent subclinically or develop as a new-onset disease.

COVID-19 in a pregnant cystic fibrosis carrier with myasthenia gravis: A case report

A 16-year-old primigravida was diagnosed with COVID-19 in her second trimester. She decompensated quickly and had to be admitted to hospital and intubated. She was diagnosed with a fetal demise after being intubated and neurology suspected myasthenia gravis due to neurologic symptoms. Due to pan-sinusitis and increased mucus secretion, cystic fibrosis screening was ordered. After she was extubated, cervical ripening and induction was performed with eventual vaginal delivery without maternal complications. Myasthenia gravis and cystic fibrosis carrier status were confirmed after the patient was discharged.

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Cystic fibrosis carrier status may increase the risk for severe COVID-19.

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COVID-19 and myasthenia gravis in pregnancy may change treatment options.

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Cystic fibrosis screening may be recommended to improve maternal outcomes.