pregnancy and myasthenia gravis

My First Pregnancy with an MG Diagnosis

I’m 9 months pregnant and about to have our third baby any day. Although my symptoms with myasthenia gravis (MG) started presenting during my second pregnancy (more than 10 years ago), this is the first pregnancy with an official diagnosis of MG that I lived with for the past 10 years.

We did not know what to expect

This pregnancy came as a complete surprise, and to be frank, we thought we would take the surrogacy route if we ever wanted another baby again. Thankfully, I had been doing really well for almost an entire year prior to this pregnancy. I actually was able to get off of Sub-Q, which I had used for over 5 years, and I was on the lowest dose of prednisone I had ever been on, 3.5mg daily a year prior as well. Prednisone was also the only medication needed. No Mestinon, no other prescriptions.

When I got pregnant, I was definitely concerned, however. My husband and my family were as well since we had no idea what to expect and because I had been doing so well. I’ve heard that the ideal time to get pregnant for MGers was 7-plus years after diagnosis so being that it’s been 10 years for me, I was optimistic yet fearful.

The first 2 trimesters were okay

The first trimester was pretty uneventful. Despite having some double vision issues and a handful of times where my mouth became weak and I couldn’t form the faces I wanted, I had no other symptoms. I was also able to remain on the same dosage of prednisone, with my doctor’s approval of course. I even had COVID during the first trimester where I had a mild but otherwise, manageable flare. I was relieved to say the least.

The second trimester was entirely uneventful. I had no MG symptoms at all for the entire time and it was almost as if I was in remission although still on a low dose of prednisone. This was also a huge relief.

Difficulty breathing in the third trimester

Then came the third trimester. I believe due to the baby being so high, my breathing was compromised and I felt pretty terrible off and on. It was super hard to get a satisfying breath and the double vision returned a lot more frequently than with the first trimester. I still opted to keep my medication the same with a plan to increase the prednisone and or try Mestinon if other symptoms started appearing.

My breathing and vision would come and go so I mostly did my best to rest and relax when it got challenging. I tend to suffer in silence so it would have probably been in my best interest to try to increase my prednisone and/or take the Mestinon at the time, but I eventually got through the flare. Even though my doctor assured me both medications were safe, I’m always hesitant to take anything while pregnant.

As I approached my due date, my baby began to drop, which opened up my diaphragm a lot and made it much less challenging to get a good breath. Although I still get winded, which could be due to pregnancy alone and/or a combination of pregnancy and MG, it is a lot more bearable and more comfortable than before.

Preparing for delivery

I’m due soon and feel pretty good. I’d be lying if I said I was feeling good about delivery though. I am scheduled for a C-section since I’ve had 2 in the past already, and I know how surgery and a change in medications can impact MG. I’m trying to stay optimistic but will be relieved when it’s all over and I know how I’ll respond and recover.

I’ve been working closely with both doctors and the anesthesiologist so we hopefully have a good plan in place. My doctor had said that the most challenging times in pregnancy for someone with MG are the first trimester, shortly after delivery, and up to a few weeks postpartum. Fingers crossed that this delivery is as uneventful as the pregnancy!

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