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Deciding whether or not to have children is probably one of the biggest decisions you’ll ever make. And if you’re committed to becoming a parent, the question, “When is the right time?” is another story. These decisions can be even more challenging when you live with a chronic condition like myasthenia gravis (MG).
It’s natural to wonder whether pregnancy will make your MG worse, or whether the medications you’re taking to control symptoms can harm your baby. Although people with MG may have an increased risk of pregnancy complications and disease flare-ups, under appropriate medical care, many can have a healthy pregnancy and safe childbirth.
In this article, we’ll review the main factors to know if you’re living with MG and thinking of planning a family.
Some people with MG want to have children but choose not to because of concerns about the potential risks to their health or their baby’s safety. As long as you’re under the care of a medical team with specialists experienced in treating MG during pregnancy, there’s no reason not to try to conceive.
Let’s look into the worries you might have and what research says about the risks with MG and starting a family.
Neither MG itself nor medications most commonly taken for MG are associated with fertility problems in women. A study in Frontiers in Neurology found that women with MG usually don’t have problems getting pregnant.
According to an article in Henry Ford Health Scholarly Commons, a platform that shares research from Henry Ford Health professionals, the medications commonly used to manage MG in men are unlikely to affect their ability to father children. However, some studies show that drugs including azathioprine and methotrexate might harm developing sperm. Therefore, some neurologists may recommend that males discontinue them around 3 months before trying for a baby.
Some people with MG might have additional autoimmune disorders that might be associated with decreased fertility. This includes:
If you have these or any other health conditions apart from MG, it’s vital to discuss all of your diagnoses and treatments with your medical team before you start planning a family.
Sexual dysfunction is common in people with MG, especially those over 40. Although it doesn’t affect fertility, it can make getting pregnant more challenging. The good news is that sexual dysfunction can often be treated.
For the majority of people with well-controlled MG, pregnancy goes smoothly. The rate of miscarriage and most pregnancy complications is similar in people with MG to that in people without the condition.
Some studies show that breaking water and preterm labor (giving birth before the 37th week of pregnancy) might be slightly more common if you have MG. However, the evidence is inconclusive.
It’s normal to worry about the possibility of MG worsening during pregnancy. The highest risk of a flare, also called an exacerbation, is during the first trimester (first 12 weeks) of pregnancy and right after giving birth. Exacerbation is estimated to occur in around 1 in 3 women with MG during this time, according to Wolters Kluwer UpToDate, an online resource that provides medical information for health care professionals. Emotional and physical stress, as well as infections, are well-known contributors to the worsening of MG.
Most medications used to treat MG are safe to use during pregnancy. This generally includes:
Other treatment options, such as intravenous immunoglobulin (IVIG) and plasmapheresis (plasma exchange), may also be used safely if needed.
On the other hand, most doctors agree that some drugs must be discontinued to avoid the possibility of harming the baby. Here are some MG medications to avoid if you are pregnant:
There may not be studies on the effects of newer treatments for MG during pregnancy. Your MG specialist can advise you on whether or not your current treatments are safe to keep taking while trying to conceive or during pregnancy.
Giving birth is safe for people with MG. Vaginal delivery is encouraged, however, some evidence shows slightly higher rates of cesarean sections as well as a slightly more common use of instruments — forceps and vacuum — to help with the birth.
Anesthesia can be an issue for people with MG. Fortunately, if you have MG, you can safely receive an epidural for pain management during labor. Most pain-numbing medications are safe to use during delivery.
As discussed, about 1 in 3 women has a flare of MG symptoms during pregnancy or shortly after birth. Myasthenic crisis — a life-threatening complication of MG in which breathing muscles become too weak to function — is estimated to affect around 8 percent of new mothers with MG, per Wolters Kluwer UpToDate. Myasthenic crises are emergencies that must be managed at a hospital.
If you have MG and want to breastfeed, it’s highly encouraged, even if plasma exchange or IVIG is needed.
Breast milk won’t make it more likely for the baby to get MG. Actually, it’s the other way around — breast milk has many benefits for the baby and even lowers the risk of developing an autoimmune disease later in life.
However, switching to formula or donor breast milk might be advised if you’re using one of these medications:
These drugs pass into breast milk and can cause serious side effects in babies, including immunosuppression (reduced ability to fight infections).
If you have MG, your baby will be monitored in a special care nursery for the first two to three days of their life. There, the neonatology team can be on the lookout for any signs of low muscle strength and poor sucking, which might be a sign of a temporary condition called transient neonatal myasthenia gravis (TNMG).
TNMG is an autoimmune disorder found in 10 percent to 20 percent of newborns born to those with MG. This can happen when MG antibodies enter the babies’ system by crossing the placenta, leading to symptoms similar to their mother’s MG.
Eventually, these antibodies are broken down, and the muscle weakness goes away. This process might take up to four weeks.
Usually, TNMG doesn’t require any treatment, and the outcomes are excellent if the baby is properly treated. If your first baby has TNMG after birth, your later children might have it, too.
Try not to worry if your child needs to go to the special care nursery after birth. If you feel well enough, you’ll be able to visit every few hours to breastfeed and spend some quality time together.
MG isn’t inherited in most cases, so there are no official recommendations for genetic testing. Although about 3 percent to 5 percent of people with MG have other family members with MG or other autoimmune disorders, MedlinePlus reports there’s no clear pattern of inheritance.
If you’re diagnosed with MG and are thinking of expanding your family, planning should be done well in advance. However, there are no official guidelines to help you decide when’s the right time to have a baby, and there’s no consensus on how much time should pass from stopping using certain drugs before conceiving.
Some studies from the journal Cureus suggest that pregnancy should ideally be postponed for at least two years after an MG diagnosis. This, especially in women with unstable MG, might potentially lower the risk of MG flares during pregnancy, as well as the risks to the baby.
If you have MG and are considering pregnancy, make sure to plan ahead. Let all members of your health care team know about your intention to have a baby.
Staying in close communication with your medical team will help make sure you’re well-informed about drug safety and make any needed changes to your treatment plan well in advance.
When choosing a hospital for childbirth, look for a medical center that offers a multidisciplinary approach, with specialist doctors available, and has an experienced neonatal intensive care unit.
Even if everything goes smoothly, a pregnancy with MG is a high-risk pregnancy. Look for an obstetrician who specializes in maternal-fetal medicine and is experienced in managing complicated pregnancies. Make sure they have all the details of your medical history.
It’s a good idea to meet with both your neurologist and your chosen obstetrician before trying to conceive. This way, you can get answers to your questions and address any concerns ahead of time. With solid information and a trusted medical team, you’ll be well on your way to planning a safe and healthy pregnancy with MG.
On MGteam, the social network for people with myasthenia gravis and their loved ones, members come together to ask questions, give advice, and share their stories with others who understand life with MG.
Are you planning a family while living with MG? Have you had children since being diagnosed? Share your experience in the comments below, or start a conversation by posting on your Activities page.
Rugilė Kančaitė, M.D.
is a doctor turned freelance health writer, medical advisor, and content reviewer.
Learn more about her here.
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