Neonatal myasthenia gravis and pregnancy

The neonatal myasthenia gravis is a very rare kind of autoimmune disease that is mainly inherited. A baby born to a myasthenic mother has a greater chance to suffer. As neonatal myasthenia gravis is not chronic and goes away in weeks after birth but, the prenatal diagnosis is the more effective way to deal with it.

 

Studies show that 3 in 25 and 2 in 5 babies delivered by the myasthenic mother may have the neonatal form of myasthenia gravis. In pregnancy also can cause complications like a myasthenic crisis.

 

What causes neonatal myasthenia gravis?

 

The maternal antibodies that cross the transplacental barrier are the most responsible for it. These antibodies do their work against the acetylcholine receptors. In addition to that, the receptors are mainly seen in the neuromuscular junction. It also works against the antigens like nicotinic acetylcholine receptors(AChR) and muscle-specific receptor tyrosine(MusKR).

 

What are the fetal signs of neonatal myasthenia gravis?

 

Before delivery, the fetus shows some abnormal signs of transient neonatal myasthenia gravis. Also shows some symptoms between 24hrs after birth. So, the symptoms are like;

  • Reduced fetal movement
  • Polyhydramnios
  • Arthrogryposis multiplex congenital( risk of having joint contracture)
  • Risk of having swallowing difficulty as well as muscle weakness.

 

Sign and symptoms in babies are like;

  • Difficulty in respiration
  • Requirement of mechanical ventilation
  • Sucking difficulty
  • Difficulty in feeding
  • The baby looks floppy 
  • Cry weakly
  • Dropping eyes
  • Lack of facial expression

 

But, all these symptoms go away in weeks and months when the normal antibodies replace the maternal antibodies. Also should not compare the neonatal myasthenia gravis with the congenital and juvenile myasthenia gravis. Because both congenital and juvenile MG are chronic. It lasts for life long.

 

Signs and symptoms of congenital myasthenia gravis

 

  • Generalized weakness in the upper and lower extremities
  • Weak eyelids
  • Poor muscles control
  • Delay in sitting, crawling, and walking, and other psychomotor activities like toilet training. 
  • Difficulties in feeding

Sign and symptoms of juvenile myasthenia gravis

 

  • Feeling tired by doing little activity
  • Difficulty in chewing and swallowing
  • Drooping eyelids
  • Muscles are too weak to allow them to bend their limbs

 

Diagnosis for neonatal myasthenia gravis

Some diagnostic evaluations are done before delivery are like;

  • Ultrasound 

Here the high magnitude and frequency sound waves are to create the image of blood vessels, organs, and growth of a developing baby.

  • Fetal monitoring

In fetal monitoring, the physician also uses a fetoscope to look for signs of muscle weakness to detect the myasthenia gravis in the baby.

  • Another fetal testing 

Doppler flow studies are done to examine the uterus and umbilical cord. Also to monitor the problems related to fetal growth and preeclampsia.

  • Muscle biopsy

A small muscle mass of the baby is taken as a sample. After that, it is examining to detect the condition.

What is the confirmatory diagnosis for this disease?

 

The Tensilon test is the most confirmatory test for myasthenia gravis. In this test, a small amount of tensilon injected into the child. And If the child has myasthenia then a normal and small increase in muscle tone is noted.

 

Other tests are like:

  • Antibody testing for anti-acetylcholine receptor
  • Intramuscular neostigmine test
  • Electromyogram or nerve conduction study

 

Complications

The complications for the mother having this disease are like;

  • Preterm labor

It occurs due to the medication use by the mother to treat myasthenia gravis.

  • Difficulty in delivery

Myasthenia gravis affects the muscles which can use for pushing the baby during delivery. But, it does not affect the muscle of the uterus.

 

How to manage the neonatal myasthenia gravis?

 

  • As the neonatal myasthenia gravis appears in between 7-11 days of life, the baby should undergo close observation. In this period the physician monitors any signs of respiratory distress.
  • Provide mechanical ventilation in case of severe respiratory distress.
  • If the baby shows the sign of poor sucking, then intravenous feeding in the neonatal ICU.
  • Also the advice the myasthenic mother should not use medications like magnesium sulfate. Because it blocks the nerve-muscle connection. And cause severe muscle weakness.
  • In surgical intervention, thymectomy( surgical removal of the thymus gland) should be recommended.

 

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