Myasthenia Gravis and Family Planning: How Do Neurologists Advise Their Patients?

Aim: Since the onset of myasthenia gravis (MG) often occurs at a crucial stage of life of family planning, questions about pregnancy are of great practical importance in the treatment of MG patients. The aim of this study was to assess the knowledge and counseling behavior of neurologists in outpatient practice and physicians who work in specialized myasthenia centers regarding family planning in patients with MG. Methods: A questionnaire consisting of demographic data and 15 vignettes on the subjects' wish for a child, pregnancy, delivery and fertility was sent to all practicing neurologists in Berlin as well as to physicians who work in specialized myasthenia centers. The survey was completely anonymous. Results: Of the physicians in outpatient practice 10% and of the physicians in specialized centers 67% returned completed questionnaires. Overall, consulting expertise was higher in the specialized centers than in outpatient practices; however, the rate of wrong recommendations was very low in both groups of physicians. The neurologists in outpatient practice would refer appropriate cases more frequently to colleagues. The drugs that were deemed harmless most often with respect to fertility were pyridostigmine, intravenous immunoglobulins and steroids. Pyridostigmine and steroids were also most frequently named in the context of maintaining or changing the medication (in the case of a desire for a child or pregnancy). Conclusion: Offer of active advice and support for affected patients on the topics of wish for a child, pregnancy, delivery and lactation should take place in a specialized and interdisciplinary environment.