探讨妊娠合并重症肌无力(MG)患者的围产结局及导致其孕期及产褥期MG病情恶化影响因素。

选择2015年1月至2023年12月在四川大学华西第二医院或厦门大学附属妇女儿童医院分娩的35例妊娠合并MG患者为研究对象。这35例患者，共计妊娠71次，其中活产为39次。根据35例妊娠合并MG患者39次活产中，该病是否导致患者孕期及产褥期MG病情恶化，将其分别纳入恶化组[n＝6，孕期及产褥期MG病情加重或发生肌无力危象(MC)]与稳定组(n＝33，孕期及产褥期MG病情稳定)。对于有≥2次妊娠的患者，进行分组与数据分析时，每次妊娠作为1例患者进行处理。采用回顾性分析方法，收集所有患者临床特征、妊娠经过、围产结局及MG病情转归等临床资料，并采用成组t检验或Mann-Whitney U检验或Fisher确切概率法，对2组患者临床资料进行比较，分析导致妊娠合并MG患者孕期与产褥期发生MG病情恶化的潜在危险因素。本研究通过四川大学华西医院医学伦理委员会审批(伦理号：2019-536)。

①本研究35例妊娠合并MG患者39次活产中，3例为双胎，活产儿为42例。39次活产中，该病导致孕期及产褥期MG病情加重者为4例(10.3%)，发生MC者为2例(5.1%)，其余33例(84.6%)孕期及产褥期MG病情均平稳，无严重产科并发症发生；分娩孕龄为(38.5±2.4)孕周。其中，7例(17.9%)发生早产，28例(71.8%)为剖宫产术分娩，10例(10.3%)产后转重症监护病房(ICU)。分娩的42例新生儿中，2例(4.8%)发生新生儿一过性MG(TNMG)，8例(19.0%)转新生儿ICU(NICU)，无围产儿死亡者。②恶化组患者孕前MG定量评分(QMG)和孕期需要使用药物治疗MG者占比分别为10.5分(6.5分，16.0分)与100.0%(6/6)，均显著高于稳定组的6.0分(4.0分，8.0分)与45.5%(15/33)，并且差异均有统计学意义(Z＝－1.97、P＝0.049，P＝0.020)。

妊娠合并MG患者孕期及产褥期MG病情多平稳，并且围产结局良好。但是，孕前QMG高和孕期需要采取药物控制MG病情者发生疾病恶化风险增加，临床应尤其重视此类孕妇的孕期及产褥期管理。

To investigate the perinatal outcomes of pregnant women with myasthenia gravis (MG) and risk factors leading to disease exacerbation of MG during pregnancy and puerperium.

A total of 35 pregnant women with MG in West China Second University Hospital, Sichuan University and Women′s and Children′s Hospital, Xiamen University from January 2015 to December 2023 was selected as research subjects. These 35 patients had a total of 71 pregnancies, of which 39 were live births. These 39 live births were divided into two groups: deterioration group [n=6, with a worsened MG or myasthenic crisis (MC) during pregnancy and puerperium] and stable group (n=33, with a stable MG during pregnancy and puerperium). For patients with ≥ 2 pregnancies, each pregnancy was considered as one case when grouping and data analysis. Clinical characteristics, pregnancy courses, perinatal outcomes, and MG prognosis were retrospectively collected and analyzed. Independent-samples t test or Mann-Whitney U test or Fisher′s exact test was used to explore the potential risk factors for MG exacerbation. This study was approved by the Medical Ethics Committee of West China Hospital, Sichuan University (Ethics No. 2019-536).

①Among the 35 pregnant women with MG, including 39 cases of live birth, 3 cases of twin pregnancies and 42 neonates. Among the 39 cases of live birth, 4 cases (10.3%) experienced a worsened MG during pregnancy and puerperium, 2 cases (5.1%) developed MC, and the remaining 33 cases (84.6%) had a stable MG during pregnancy and puerperium. No serious obstetrical complications occurred. The gestational age of delivery was (38.5±2.4) gestational weeks. Preterm birth occurred in 7 cases (17.9%). 28 cases (71.8%) were delivered by cesarean section. 10 cases (10.3%) were admitted to intensive care unit (ICU) after delivery. 2 (4.8%) of the 42 neonates experienced transient neonatal MG (TNMG), and 8 neonates (19.0%) were admitted to neonatal ICU (NICU) after birth. There was no perinatal death. ②The quantitative MG (QMG) score before pregnancy and the proportion of patients needing for medication to treat MG during pregnancy in deterioration group were 10.5 points (6.5 points, 16.0 points) and 100.0% (6/6), respectively, which were both significantly higher than those 6.0 points (4.0 points, 8.0 points) and 45.5% (15/33) in stable group (Z=-1.97, P=0.049; P=0.020).

Most pregnant women with MG could have a stable condition during pregnancy and puerperium and have good perinatal outcomes. However, those with a high QMG score before pregnancy or need medication to control MG during pregnancy and puerperium have an increased risk of disease exacerbation of MG, thus special attention should be paid to the pregnancy and puerperium management of these patients by clinicians.