T he global prevalence of obesity (body mass index [BMI], 30 kg/m 2 ) has tripled since 1975, and it is estimated that, in 2016, >1.9 billion adults were overweight (BMI, 25e29.9 kg/m 2 ), of which >650 million adults were obese. 1 Among women giving birth in the United States in 2014, 50.4% were either overweight or obese. 2 In addition, adults with a BMI of kg/m 2 comprise the most rapidly growing class of obesity in the United States. 3 Pregnant women who are classified as overweight or obese are known to be at increased risk for adverse maternal and fetal/neonatal outcomes. 4,5 However, the increased risk of pregnancy complications with each obesity class over that for women with standard BMI has not been assessed systematically. Given the high prevalence of obesity among women of childbearing age, the importance of estimating pregnancy risk with increasing BMI categories has become more pertinent than ever. ObjectiveThe objective of this study was to metaanalyze data that compares pregnancy outcomes in women with obesity and that are stratified by obesity class, with the view to counselling women and informing preventative strategies preconceptionally and during pregnancy. MethodsThis study was conducted as part of study to scrutinize the effect of obesity on mode of delivery; the study protocol

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Introduction: Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory disorder of the central nervous system characterized by severe, antibody-mediated astrocyte loss with secondary demyelination and axonal damage, predominantly targeting optic nerves and the spinal cord. Recent publications have alluded to increased disease activity during pregnancy, and adverse maternal and fetal outcomes in patients with NMOSD. Our objective was to systematically review published literature to help counsel and manage women with NMOSD contemplating pregnancy. Methods: We searched five databases including MEDLINE and EMBASE, for English-language publications describing pregnancies in women with NMOSD. Article selection, data extraction, and risk-of-bias assessment using Joanna Briggs' critical appraisal tool for case reports and case series, were performed in duplicate. Pooled incidences were calculated where possible, and a narrative summary was provided. Results: Of 2,118 identified titles, 22 case reports and seven case series, representing 595 pregnancies in 389 women, were included. The mean maternal age was 28.12 ± 5.19 years. At least 20% of cases were first diagnosed during pregnancy. There were no maternal deaths. Pooled estimates for clinical outcomes could not be obtained due to inadequate reporting. NMOSD-related disability and relapses increased considerably during pregnancy and especially in the immediate postpartum period. Although a high proportion of early pregnancy losses were reported, an association with disease activity or therapeutic interventions could not be established. Apart from one publication which reported an increased risk of preeclampsia, there was no increase in adverse obstetric outcomes including preterm birth, fetal growth restriction or congenital malformations. Initial attacks and relapses were successfully managed with oral or intravenous D'Souza et al. NMOSD and Pregnancy: Systematic Review corticosteroids and immunosuppressants, and refractory cases with immunoglobulin, plasma exchange and immunoadsorption. Conclusion: Increased NMOSD-related disability and relapses during pregnancy the postpartum period may respond to aggressive management with corticosteroids and immunosuppressants such as azathioprine, which are safely administered during pregnancy and lactation. Emerging safety data on monoclonal antibodies during pregnancy, make these attractive options, while intravenous immunoglobulin, plasma exchange and immunoadsorption can be safely used to treat severe relapses. The complex interplay between NMOSD and pregnancy outcomes would be best understood through prospective analysis of data collected through an international registry. Disclosure: Dalia Rotstein has served as a consultant or speaker for Alexion and Roche. She has received research support from Roche Canada. Rohan D'Souza has served as a consultant and speaker for Ferring Canada Inc and Ferring Global Inc, on topics unrelated to this manuscript. The other authors have no relevant relationships to disclose.