Pregnancy in neuromyelitis optica spectrum disorder: A multicenter study from South China

Huang, Yitong; Wang, Yuge; Zhou, Yifan; Huang, Qiao; Sun, Xiaobo; Chen, Chen; Fang, Ling; Long, Youming; Yang, Hui; Wang, Honghao; Li, Caixia; Liu, Zhengqi; Hu, Xueqiang; Kermode, Allan G.

doi:10.1016/j.jns.2016.11.054

Cited by 24 publications

(43 citation statements)

References 21 publications

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“…Fragoso et al 37 reported mean EDSS increase of 1.7 in 17 women after 1 year. Shi et al 40 report the nonsignificant mean EDSS increase of 0.5 points at 6 months in 16 women The first symptoms of NMOSD developed in 20%-47% of women during pregnancy or within 12 months of childbirth or miscarriage, 35,38,39,43 a rate far higher than expected had pregnancy not been a contributing factor.…”

Section: Nmosd Outcomes During Pregnancymentioning

confidence: 99%

“…Relapse rate, disability scale, and cofactors Retrospective studies have been conducted in seven populations ( Table 2). [35][36][37][38][39][40] Additional case reports describe pregnancy-related NMOSD experiences of interest. 41,42 A synthesis of the data suggests that relapses occur at the same rate during pregnancy but an increased rate during the first 3 months postpartum compared to pre-pregnancy.…”

Section: Nmosd Outcomes During Pregnancymentioning

confidence: 99%

“…44,e43 Hyperemesis gravidarum may be confused with the NMOSD-associated area postrema syndrome. 41,45 Pregnancy outcomes in NMOSD Miscarriages and fetal death NMOSD increased the risk of miscarriage 35,38,39 independent of risk of concomitant autoimmunity such as antiphospholipid syndrome. 43 43% of pregnancies ended in miscarriages after NMOSD onset compared to 7% before, usually in the first trimester; the association persisted after correction for differences in maternal age and prior miscarriage.…”

Section: Nmosd Outcomes During Pregnancymentioning

confidence: 99%

“…Spinal anesthesia has generally been found safe in NMOSD. [35][36][37][38][39] However, NMOSD began in five patients within 6 months of epidural or spinal anesthesia (n = 3) e4,e5 or relapsed postpartum (n = 2); e6-e8 three of the five patients received bupivacaine. Recommendations are difficult based on limited case reports, but one might consider avoiding bupivacaine for spinal anesthesia.…”

Section: Spinal Anesthesia and Nmosdmentioning

confidence: 99%

“…Oral corticosteroids (FDA Class C; FDA Class D in first trimester). Oral corticosteroids have been continued during pregnancy in NMOSD 29,38,40 and other conditions, e31 at the lowest possible dose, typically less than 20 mg per day. Prednisone is metabolized by the placenta; only 10% crosses into the fetal circulation.…”

Section: Maintenance Of Is Therapiesmentioning

confidence: 99%

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Neuromyelitis optica spectrum disorders and pregnancy: Interactions and management

et al. 2017

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Neuromyelitis optica spectrum disorders (NMOSD) predominantly affect women who are of childbearing age. Understanding the interactions between pregnancy and NMOSD is important for clinical management. Aquaporin-4 (AQP4), the most common target antigen in NMOSD, is expressed on placenta in early pregnancy. A variety of immune and cytokine changes in pregnancy may impact pregnancy outcomes in NMOSD patients. Relapses continue during pregnancy and increase in frequency postpartum. Preeclampsia and fetal loss are more frequent in NMOSD than in controls. Transfer of AQP4-immunoglobulin G (IgG) from mother to baby occurs but appears not to cause disease. Several treatment options are relatively safe and mitigate the risk of relapse during pregnancy and postpartum. For patients with active NMOSD, it may be advisable to continue immunotherapy during pregnancy.

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Section: Nmosd Outcomes During Pregnancymentioning

confidence: 99%

Section: Nmosd Outcomes During Pregnancymentioning

confidence: 99%

Section: Nmosd Outcomes During Pregnancymentioning

confidence: 99%

Section: Spinal Anesthesia and Nmosdmentioning

confidence: 99%

Section: Maintenance Of Is Therapiesmentioning

confidence: 99%

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Neuromyelitis optica spectrum disorders and pregnancy: Interactions and management

et al. 2017

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Analysis of Pregnancy-Related Attacks in Neuromyelitis Optica Spectrum Disorder

Wang

Zhou

et al. 2022

JAMA Netw Open

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IMPORTANCERisk of relapse may be increased in the postpartum period of neuromyelitis optica spectrum disorder (NMOSD). Information regarding factors associated with pregnancy-related attacks is still lacking. OBJECTIVES To identify factors associated with pregnancy-related NMOSD attacks, investigate the integrated annualized relapse rate (ARR) and Expanded Disability Status Scale (EDSS) score in each phase of pregnancy, and summarize pregnancy outcomes and complications in patients with NMOSD. DATA SOURCES An electronic search was performed in the MEDLINE, PubMed in-process and non-MEDLINE, EMBASE, Web of Science, and Cochrane databases using the OvidSP search platform, updated through December 30, 2021. STUDY SELECTION All published and unpublished studies in English were considered, covering all patients with NMOSD with an informative pregnancy. DATA EXTRACTION AND SYNTHESIS Two independent reviewers extracted the published data with a standardized procedure following MOOSE and PRISMA guidelines. The end points were calculated with the DerSimonian and Laird inverse variance (for random effects) method. MAIN OUTCOMES AND MEASURESThe primary outcome was the rate of pregnancies with pregnancy-related NMOSD attacks, measured by risk ratios (RRs). The mean differences (MDs) in ARR and EDSS scores between each phase of pregnancy, pregnancy outcomes, and complications were defined as the secondary outcomes. RESULTSA total of 15 studies were analyzed, including 443 patients with NMOSD with 639 informative pregnancies. Patients receiving immunosuppressive treatment during pregnancy (RR, 0.43; 95% CI, 0.32-0.57; P < .001) and with older age at conception (RR, 0.67; 95% CI, 0.47-0.95; P = .02) had lower rates of pregnancy with pregnancy-related attacks. The increase in the ARR was highest in the first trimester after delivery compared with before pregnancy (MD, 1.28; 95% CI, 0.94-1.62; P < .001). The EDSS scores increased significantly both during pregnancy (MD, 0.44; 95% CI, 0.20-0.69; P < .001) and in the postpartum period (MD, 0.88; 95% CI, 0.51-1.26; P < .001) compared with before pregnancy. CONCLUSIONS AND RELEVANCEThis systematic review and meta-analysis found that receiving immunosuppressive treatment during pregnancy and older age at conception were associated with (continued) Key Points Question What are the factors associated with pregnancy-related attacks in neuromyelitis optica spectrum disorder? Findings This systematic review and meta-analysis of 15 studies with 443 patients found that receiving immunosuppressive treatment during pregnancy and older age at conception were associated with lower risk of pregnancy-related attacks. Annualized relapse rate was elevated especially during the first trimester after delivery while the Expanded Disability Status Scale score worsened during pregnancy and the postpartum period. Meaning These findings suggest that receiving immunosuppressive treatment during pregnancy and older age at conception were associated with protection against pregnancy-related neuromyelitis opti...

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Effects of pregnancy on neuromyelitis optica spectrum disorder and predictors of related attacks

Shi

Chen

et al. 2022

Ann Clin Transl Neurol

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Objective: Our study aimed to investigate the influence of pregnancy on the course of neuromyelitis optica spectrum disorders (NMOSD) and to explore the independent predictors of pregnancy-related attacks. Methods: We performed a retrospective study of patients with NMOSD based on the Wingerchuk 2006 or the revised Wingerchuk 2015 criteria. Demographic, clinical, and pregnancy data were recorded. We compared the annualized relapse rate (ARR) before, during, and after pregnancy. The Expanded Disability Status Scale (EDSS) score was used to assess the degree of disability. Multivariate Cox proportional hazards models were used to identify the independent risk factors that predict pregnancy-related attacks. Results: There were 202 informative pregnancies following symptom onset in 112 women with NMOSD. The ARR in the first-trimester postpartum period (1.44 AE 2.04) was higher than that before pregnancy (0.23 AE 0.48; p < 0.001) and during pregnancy. The EDSS score increased from 1.40 AE 1.38 before pregnancy to 1.99 AE 1.78 postpartum (p = 0.004). Multivariate Cox proportional hazards models indicated that increased disease activity 1 year before conception (HR = 1.79, 95% CI 1.09-2.92, p = 0.021) and lack of immunotherapy during pregnancy and the postpartum period (HR = 5.25, 95% CI 1.91-14.42, p = 0.001) were independent risk factors that predicted pregnancy-related attacks. Interpretation: The postpartum period is a particularly high-risk time for the onset and relapse of NMOSD. Pregnancy exerted detrimental effects on the disease courses of NMOSD. Immunotherapy during pregnancy and the postpartum period might be recommended to decrease the risk of pregnancy-related attacks. Larger-scale prospective studies are warranted to confirm our findings.

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Pregnancy in neuromyelitis optica spectrum disorder: A multicenter study from South China

Cited by 24 publications

References 21 publications

Neuromyelitis optica spectrum disorders and pregnancy: Interactions and management

Neuromyelitis optica spectrum disorders and pregnancy: Interactions and management

Analysis of Pregnancy-Related Attacks in Neuromyelitis Optica Spectrum Disorder

Effects of pregnancy on neuromyelitis optica spectrum disorder and predictors of related attacks

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