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Myasthenia Gravis and Pregnancy

Yıl 2016, Cilt: 25 Sayı: 1, 33 - 40, 31.03.2016

Öz

Myasthenia gravis is an autoimmune disease affecting  nearly one million individuals worldwide. Myasthenia gravis develops due to antibodies against the nicotinic acetylcholine receptoror othe r postsynaptic antigens. Hyperplasia and tumours of the thymus can cause the abnormal production of these autoantibodies. Diagnosis of myasthenia gravis could be made through recognition of the cardinal clinical features of fatigable, painless muscle weakness with confirmatory serum autoantibody analysis and electromyographic evidence of disordered neuromuscular transmission, thereby excluding other differential diagnoses. Symptomatic improvement may be achieved through the use of anticholinesterase drugs, although usually immune-directed treatments are required to control the disease. The disease does not affect fertility in women and patients can have children. In this paper management to pregnant myasthenia gravis patients will be discussed in detail.

Kaynakça

  • 1. Gilhus NE, Owe JF, Hoff JM, Romi F, Skeie GO, Aarli JA. Myasthenia gravis: a review of available treatmentapproaches. Autoimmune Dis 2011;2011:847393.
  • 2. Mays J, ButtsCL. Intercommunicationbetween the neuroendocrineandimmunesystems:focuson myastheniagravis. Neuroimmunomodulation.2011;18:320–7.
  • 3. Buckley C, Douek D, Newsom-Davis J, Vincent A, Willcox N. Mature, longlivedCD4+ andCD8+ T cellsaregeneratedbythethymomainmyastheniagravis. Ann Neurol. 2001;50:64-72
  • 4. DrachmanD.Myastheniagravis. N Engl JMed.1994;330:1797–1810.
  • 5. Bahçi, ZB., Saygı, S. Gebelik ve nörolojik hastalıklar. Hekimler Birliği Vakfı Jinekoloji ve Obstetrik Bülteni. 1993;2(2):1-10.
  • 6. Hantai D, Richard P, Koenig J, Eymard B. Congenital myasthenic syndromes. Curr Opin Neurol. 2004;17:539–51.
  • 7. Djelmis J, SostarkoM, Mayer D, Ivanisevic M. Myastheniagravis in pregnancy: reporton 69cases. Eur J Obstet Gynecol Reprod Biol.2002;104:21-5.
  • 8. Da Silva FC, do Cima LC, de Sá RAM. Myastheniagravis andpregnancy. In Neurological Disorders andpregnancy(Ed A Minagar):55-68. Burlington,MA,Elsevier.
  • 9. Batocchi AP, Majolini L, Evoli A, Lino MM, MinisciC,TonaliP.Courseandtreatmentof myasthenia gravisduringpregnancy. Neurology.1999;52:447–52.
  • 10. PlaucheWC.Myastheniagravis.Clin Obstet Gynecol.1983;26:592-604. 11. Ferrero S, Esposito F, Biamonti M, Bentivoglio G, Ragni N. Myasthenia gravis during pregnancy. Expert Rev Neurother.2008;8:979-88.
  • 12. Hoff JM, Daltveit AK, Gilhus NE. Myastheniagravis in pregnancyandbirth: identifying riskfactors, optimisingcare.Eur J Neurol.2007;14:38-43.
  • 13. Berlit S, Tuschy B, Spaich S, Sütterlin M, Schaffelder R. Myasthenia gravis in pregnancy:a case report.Case Rep Obstet Gynecol.2012;2012:736024.
  • 14. Apaydın H. Gebelik ve nörolojik hastalıklar. Klinik Gelişim Dergisi.2008;21: 138-42.
  • 15. FerreroS,PrettaS, Nicoletti A,PetreraP, Ragni N. Myastheniagravis: management issuesduring pregnancy.Eur J Obstet Gynecol.2005;121:129-38.
  • 16. Almeida C, Cautinho E, Moreira D, Santos E, Aguair J. Myasthenia Gravis and pregnancy:anaesthetic management—a series of cases. Eur J Anaesthesiol.2010;27:985-90
  • 17. Abel M, Eisenkraft JB. Anesthetic implications of myasthenia gravis. Mt Sinai J Med. 2002;69:31- 7.
  • 18. Chieza JT, Fleming I, Parry N, Skelton VA. Maternal myasthenia gravis complicated by fetal arthrogryposismultiplexcongenita. Int J Obstet Anesth.2011;20:79-82.
  • 19. Dominovic-Kovacevic A, Ilic T, Vukojevic Z. Myastheniagravis andpregnancy—case report. Curr Top NeurolPsychiatr Relat Discip.2010;18:40-3
  • 20. Briggs G, Freeman R,YaffeS. Drugs in PregnancyandLactation.Philadelphia,LippincottWilliams &Wilkins,2008.
  • 21. Gazioğlu S. Gebelikte nöromusküler hastalıklara yaklaşım. Türkiye Klinikleri Gebelik ve Nöroloji Özel Sayısı.2013;6:26-35.
  • 22. Benediktsson R, Calder AA, Edwards CR, Seckl JR. Placental 11 beta-hydroxysteroid dehydrogenase: a key regulator of fetal glucocorticoid exposure. Clin Endocrinol (Oxf). 1997;46:161–6
  • 23. Park-WyllieL, MazzottaP,Pastuszak A, Moretti ME, BeiqueL, HunnisettLetal. Birth defectsafter maternal exposure to corticosteroids: prospective cohort study and meta- analysis of epidemiologicalstudies.Teratology.2000;62:385–92.
  • 24. Carmichael SL, Shaw GM, Ma C, Werler MM, Rasmussen SA, Lammer EJ; National Birth Defects Prevention Study. Maternal corticosteroid use and orofacial clefts. Am J Obstet Gynecol. 2007;197:585.
  • 25. Kallen B. Maternal drug use and infant cleft lip/palate with special reference to corticoids. Cleft PalateCraniofacJ.2003;40:624–8.
  • 26. Czeizel AE, Rockenbauer M. Population-based case-control study of teratogenic potential of corticosteroids.Teratology.1997;56:335–40.
  • 27. Park-WyllieL, MazzottaP,Pastuszak A, Moretti ME, BeiqueL, HunnisettLet al. Birth defectsafter maternal exposure to corticosteroids: prospective cohort study and meta- analysis of epidemiologicalstudies.Teratology.2000;62:385-92.
  • 28. Gur C, Diav-Citrin O, Shechtman S, Arnon J, Ornoy, A. Pregnancy outcome after first trimester exposuretocorticosteroids:aprospectivecontrolledstudy. ReprodToxicol. 2004;18:93-101.
  • 29. Lee S, Sykes J. Cleft lip and palate. In Rhinology and Facial Plastic Surgery (Eds FJ Stucker, C de Souza, GS Kenyon, TS Lian, W Draf, B Schick):909-16. New York, NY,Springer,2009.
  • 30. Ciafaloni E, Massey JM. The management of myasthenia gravis in pregnancy. Semin Neurol. 2004;24:95-100.
  • 31. Goldstein LH. Pregnancy outcome of women exposed to azathioprine during pregnancy. Birth Defects Res A ClinMolTeratol. 2007;79:696-701.
  • 32. Matalon ST, Ornoy A, Lishner M. Review of the potential effects of three commonly used antineoplastic and immunosuppressive drugs (cyclophosphamide, azathioprine, doxorubicin on theembryoandplacenta). ReprodToxicol.2004;18:219-30.
  • 33. PolifkaJE. Teratogen update:azathioprineand6-mercaptopurine.Teratology. 2002;65:240-6.
  • 34. TeratologySociety 51st Annual Meeting, June 25-29,2011, Coronado,California, USA. Abstracts. Birth Defects Res A ClinMolTeratol.2011;91:305-420.
  • 35. Evans WE, McLeod HL. Pharmacogenomics—drug disposition, drug targets, and side effects. N Engl JMed.2003;348:538–49.
  • 36. Nulman I, Sgro M, Barrera M, Chitayat D, Cairney J, Koren G. Long-term neurodevelopment of children exposed in utero to cyclosporine after maternal renal transplant. Paediatr Drugs. 2010;12:113–22.
  • 37. Østensen M, Lockshin M, Doria A, Valesini G, Meroni P, Gordon C et al. Update on safety during pregnancy of biological agents and some immunosuppressive anti-rheumatic drugs. Rheumatology.2008;47:28-31.
  • 38. VoulgarisE. Cancerandpregnancy:acomprehensivereview.Surg Oncol. 2011;20:e175-85.
  • 39. Pisoni CN, D’Cruz DP. The safety of mycophenolate mofetil in pregnancy. Expert OpinDrug Saf. 2008;7:219-22.
  • 40. Koren G. Mycophenolate mofetil: emergingas a potential human teratogen. Can Fam Physician. 2008;54:1112-3.
  • 41. Merlob P, Stahl B, Klinger G. Tetrada of the possible mycophenolate mofetil embryopathy: a review. ReprodToxicol.2009;28:105-8.
  • 42. Lin AE, Singh KE, Strauss A, Nguyen S, Rawson K, Kimonis VE. An additional patient with mycophenolate mofetil embryopathy: cardiac and facial analyses. Am J Med Genet A. 2001;155:748-56.

Myastenia Gravis ve Gebelik

Yıl 2016, Cilt: 25 Sayı: 1, 33 - 40, 31.03.2016

Öz

Myastenia gravis, dünyada yaklaşık bir milyon kişiyi etkileyen otoimmun bir hastalıktır. Nikotinik
asetilkolin reseptörüne veya diğer postsinaptik antijenlere (kas spesifik kinaz gibi) karşı gelişen
antikorlar sonucunda myastenia gravis gelişir. Timusun hiperplazisi ve tümörü bu anormal antikorlaın
yapımına neden olur. Myastenia gravis tanısı yorgunluk, ağrısız kas güçsüzlüğü gibi kardinal belirtilere
eşlik eden serum otoantikor pozitifliği, elektromyografi de nöromüsküler iletim kusurunun gözlenmesi
ile konulur. Semptomatik tedavi antikolinesterazlarla, hastalığın kontrolü ise immun aracılı tedavilerle
yöntemleriyle yapılır. Myastenia gravisin kadınlarda fertilite üzerine etkisi yoktur, olgular çocuk sahibi
olabilirler. Bu yazıda gebelerde myastenia gravise yaklaşım detaylı olarak ele alınacaktır.

Kaynakça

  • 1. Gilhus NE, Owe JF, Hoff JM, Romi F, Skeie GO, Aarli JA. Myasthenia gravis: a review of available treatmentapproaches. Autoimmune Dis 2011;2011:847393.
  • 2. Mays J, ButtsCL. Intercommunicationbetween the neuroendocrineandimmunesystems:focuson myastheniagravis. Neuroimmunomodulation.2011;18:320–7.
  • 3. Buckley C, Douek D, Newsom-Davis J, Vincent A, Willcox N. Mature, longlivedCD4+ andCD8+ T cellsaregeneratedbythethymomainmyastheniagravis. Ann Neurol. 2001;50:64-72
  • 4. DrachmanD.Myastheniagravis. N Engl JMed.1994;330:1797–1810.
  • 5. Bahçi, ZB., Saygı, S. Gebelik ve nörolojik hastalıklar. Hekimler Birliği Vakfı Jinekoloji ve Obstetrik Bülteni. 1993;2(2):1-10.
  • 6. Hantai D, Richard P, Koenig J, Eymard B. Congenital myasthenic syndromes. Curr Opin Neurol. 2004;17:539–51.
  • 7. Djelmis J, SostarkoM, Mayer D, Ivanisevic M. Myastheniagravis in pregnancy: reporton 69cases. Eur J Obstet Gynecol Reprod Biol.2002;104:21-5.
  • 8. Da Silva FC, do Cima LC, de Sá RAM. Myastheniagravis andpregnancy. In Neurological Disorders andpregnancy(Ed A Minagar):55-68. Burlington,MA,Elsevier.
  • 9. Batocchi AP, Majolini L, Evoli A, Lino MM, MinisciC,TonaliP.Courseandtreatmentof myasthenia gravisduringpregnancy. Neurology.1999;52:447–52.
  • 10. PlaucheWC.Myastheniagravis.Clin Obstet Gynecol.1983;26:592-604. 11. Ferrero S, Esposito F, Biamonti M, Bentivoglio G, Ragni N. Myasthenia gravis during pregnancy. Expert Rev Neurother.2008;8:979-88.
  • 12. Hoff JM, Daltveit AK, Gilhus NE. Myastheniagravis in pregnancyandbirth: identifying riskfactors, optimisingcare.Eur J Neurol.2007;14:38-43.
  • 13. Berlit S, Tuschy B, Spaich S, Sütterlin M, Schaffelder R. Myasthenia gravis in pregnancy:a case report.Case Rep Obstet Gynecol.2012;2012:736024.
  • 14. Apaydın H. Gebelik ve nörolojik hastalıklar. Klinik Gelişim Dergisi.2008;21: 138-42.
  • 15. FerreroS,PrettaS, Nicoletti A,PetreraP, Ragni N. Myastheniagravis: management issuesduring pregnancy.Eur J Obstet Gynecol.2005;121:129-38.
  • 16. Almeida C, Cautinho E, Moreira D, Santos E, Aguair J. Myasthenia Gravis and pregnancy:anaesthetic management—a series of cases. Eur J Anaesthesiol.2010;27:985-90
  • 17. Abel M, Eisenkraft JB. Anesthetic implications of myasthenia gravis. Mt Sinai J Med. 2002;69:31- 7.
  • 18. Chieza JT, Fleming I, Parry N, Skelton VA. Maternal myasthenia gravis complicated by fetal arthrogryposismultiplexcongenita. Int J Obstet Anesth.2011;20:79-82.
  • 19. Dominovic-Kovacevic A, Ilic T, Vukojevic Z. Myastheniagravis andpregnancy—case report. Curr Top NeurolPsychiatr Relat Discip.2010;18:40-3
  • 20. Briggs G, Freeman R,YaffeS. Drugs in PregnancyandLactation.Philadelphia,LippincottWilliams &Wilkins,2008.
  • 21. Gazioğlu S. Gebelikte nöromusküler hastalıklara yaklaşım. Türkiye Klinikleri Gebelik ve Nöroloji Özel Sayısı.2013;6:26-35.
  • 22. Benediktsson R, Calder AA, Edwards CR, Seckl JR. Placental 11 beta-hydroxysteroid dehydrogenase: a key regulator of fetal glucocorticoid exposure. Clin Endocrinol (Oxf). 1997;46:161–6
  • 23. Park-WyllieL, MazzottaP,Pastuszak A, Moretti ME, BeiqueL, HunnisettLetal. Birth defectsafter maternal exposure to corticosteroids: prospective cohort study and meta- analysis of epidemiologicalstudies.Teratology.2000;62:385–92.
  • 24. Carmichael SL, Shaw GM, Ma C, Werler MM, Rasmussen SA, Lammer EJ; National Birth Defects Prevention Study. Maternal corticosteroid use and orofacial clefts. Am J Obstet Gynecol. 2007;197:585.
  • 25. Kallen B. Maternal drug use and infant cleft lip/palate with special reference to corticoids. Cleft PalateCraniofacJ.2003;40:624–8.
  • 26. Czeizel AE, Rockenbauer M. Population-based case-control study of teratogenic potential of corticosteroids.Teratology.1997;56:335–40.
  • 27. Park-WyllieL, MazzottaP,Pastuszak A, Moretti ME, BeiqueL, HunnisettLet al. Birth defectsafter maternal exposure to corticosteroids: prospective cohort study and meta- analysis of epidemiologicalstudies.Teratology.2000;62:385-92.
  • 28. Gur C, Diav-Citrin O, Shechtman S, Arnon J, Ornoy, A. Pregnancy outcome after first trimester exposuretocorticosteroids:aprospectivecontrolledstudy. ReprodToxicol. 2004;18:93-101.
  • 29. Lee S, Sykes J. Cleft lip and palate. In Rhinology and Facial Plastic Surgery (Eds FJ Stucker, C de Souza, GS Kenyon, TS Lian, W Draf, B Schick):909-16. New York, NY,Springer,2009.
  • 30. Ciafaloni E, Massey JM. The management of myasthenia gravis in pregnancy. Semin Neurol. 2004;24:95-100.
  • 31. Goldstein LH. Pregnancy outcome of women exposed to azathioprine during pregnancy. Birth Defects Res A ClinMolTeratol. 2007;79:696-701.
  • 32. Matalon ST, Ornoy A, Lishner M. Review of the potential effects of three commonly used antineoplastic and immunosuppressive drugs (cyclophosphamide, azathioprine, doxorubicin on theembryoandplacenta). ReprodToxicol.2004;18:219-30.
  • 33. PolifkaJE. Teratogen update:azathioprineand6-mercaptopurine.Teratology. 2002;65:240-6.
  • 34. TeratologySociety 51st Annual Meeting, June 25-29,2011, Coronado,California, USA. Abstracts. Birth Defects Res A ClinMolTeratol.2011;91:305-420.
  • 35. Evans WE, McLeod HL. Pharmacogenomics—drug disposition, drug targets, and side effects. N Engl JMed.2003;348:538–49.
  • 36. Nulman I, Sgro M, Barrera M, Chitayat D, Cairney J, Koren G. Long-term neurodevelopment of children exposed in utero to cyclosporine after maternal renal transplant. Paediatr Drugs. 2010;12:113–22.
  • 37. Østensen M, Lockshin M, Doria A, Valesini G, Meroni P, Gordon C et al. Update on safety during pregnancy of biological agents and some immunosuppressive anti-rheumatic drugs. Rheumatology.2008;47:28-31.
  • 38. VoulgarisE. Cancerandpregnancy:acomprehensivereview.Surg Oncol. 2011;20:e175-85.
  • 39. Pisoni CN, D’Cruz DP. The safety of mycophenolate mofetil in pregnancy. Expert OpinDrug Saf. 2008;7:219-22.
  • 40. Koren G. Mycophenolate mofetil: emergingas a potential human teratogen. Can Fam Physician. 2008;54:1112-3.
  • 41. Merlob P, Stahl B, Klinger G. Tetrada of the possible mycophenolate mofetil embryopathy: a review. ReprodToxicol.2009;28:105-8.
  • 42. Lin AE, Singh KE, Strauss A, Nguyen S, Rawson K, Kimonis VE. An additional patient with mycophenolate mofetil embryopathy: cardiac and facial analyses. Am J Med Genet A. 2001;155:748-56.
Toplam 41 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Bölüm Derleme
Yazarlar

Ahmet Evlice

Turgay Demir Bu kişi benim

Yayımlanma Tarihi 31 Mart 2016
Yayımlandığı Sayı Yıl 2016 Cilt: 25 Sayı: 1

Kaynak Göster

AMA Evlice A, Demir T. Myasthenia Gravis and Pregnancy. aktd. Şubat 2016;25(1):33-40. doi:10.17827/aktd.50846