Myasthenia gravis and pregnancy

Table 2 Treatment options in myasthenia gravis during pregnancy

Medication	FDA category	Effects on pregnancy	Breastfeeding
Treatment of choice
Pyridostigmine	B	None reported	No limitation (Excreted in breast milk)
Steroid	C	Cleft lip or palate (rare), low birth weight	No limitation (Excreted in breast milk)
Treatment of choice for steroid-sparing agents if indicated
Azathioprine	D	Intrauterine growth retardation, prematurity, low birth weight, hematological toxicities (lymphopenia, pancytopenia) in newborn	Limited but can be considered (Excreted in breast milk)
Cyclosporine	C	Intrauterine growth retardation, prematurity, low birth weight	Limited but can be considered (Excreted in breast milk)
Contraindicated
Mycophenolate	D	Congenital anomalies	Contraindicated
Cyclophosphamide	D	Congenital anomalies	Contraindicated
Methotrexate	X	Fetal death, congenital anomalies	Contraindicated
Insufficient data
Rituximab	C	Transient B- and CD19+-cell depletion in newborns, prematurity, low birth weight	Limited data (minimally detected in breast milk)
Eculizumab	C	Limited data (prematurity)	Limited data (not detected in breast milk)
Treatment of choice for exacerbation of MG or myasthenic crisis
IVIG	C	None reported	No limitation
Plasmapheresis	N/A	Small for gestational age	No limitation

FDA: Food and Drug Administration; MG: Myasthenia gravis; IVIG: Intravenous immunoglobulins.