Pregnancy outcomes in anti-NMDA receptor encephalitis

Abstract

ObjectiveTo report the effects of anti-NMDA receptor (NMDAR) encephalitis in pregnant patients and their babies.MethodsWe studied a retrospective cohort of patients who developed anti-NMDAR encephalitis during pregnancy or became pregnant while recovering from the encephalitis. In addition, we reviewed the English literature between 2010 and 2019 related to this topic.ResultsWe studied 11 patients; 6 developed anti-NMDAR encephalitis during pregnancy, and 5 became pregnant while recovering. There were no obstetrical complications, but 6 (55%) babies were premature. Ten newborns were healthy, and 1 (9%) developed transient respiratory distress. Nine infants had assessable follow-up (median 18 months; range, 7–96 months), and all showed normal development. We identified 21 cases in the English literature. Obstetrical complications occurred in 7 (33%) pregnancies. Two patients died of septic shock (1 baby successfully delivered), another 2 had miscarriages, and in 2, the pregnancy was terminated. Sixteen babies (76%) were delivered, 9 (56%) premature. At birth, 13/16 (81%) newborns were healthy, 2/16 (13%) had transient neurologic or respiratory symptoms, and 1 (6%) died of brain edema. Follow-up (median 12 months; range, 6–36 months) was reported for 8 children: 7 (88%) showed normal development and behavior, and 1 (13%) cortical dysplasia. Immunotherapy was used during pregnancy in 7 (64%) of our patients and 18 (86%) of the reported cases, including rituximab in 4 cases, without adverse effects.ConclusionsPatients who develop anti-NMDAR encephalitis during pregnancy or become pregnant during recovery often have obstetrical complications, but most of the newborns are healthy and appear to have normal development.

Gender issues of antibody-mediated diseases in neurology: (NMOSD/autoimmune encephalitis/MG)

“…In summary, the authors suggest, based on their own experience and publications, 68 that pregnant women during or after anti-NMDA receptor encephalitis and their relatives should be counselled that (1) there is no clear evidence of a direct immune mediated effect on foetal development and thus no indication for abortion; (2) due to intensive care treatment, seizures and possible autonomic dysfunction, the pregnancy should be considered high risk and closely monitored for signs of foetal distress; and (3) danger to the unborn child due to these complications of AE presumably outweighs possible side effects of anticonvulsive and immunosuppressive medication and these should not be withheld. Anti-NMDA receptor encephalitis should be considered in patients with post-partum psychosis as a rare but treatable differential diagnosis.…”

“…68 Five additional pregnant women (median 5 months, range 1-42 months) after a prior episode of anti-NMDA receptor encephalitis were reported. 68 Median age in this series was 23 years (range 19-37 years). No obstetric complications were reported, yet caesarean sections were done in 36% of patients due to the neurological condition of the mother.…”

“… 68 An ovarian teratoma was detected and removed in around half of the reported patients during pregnancy. 68 …”

A 24-Year-Old Female With Anti-NMDA Receptor Encephalitis: A Case Report.

“…NMDA anti-receptor IgG crosses the placental barrier, and its effects on the foetus can be variable; case of early neonatal death has been described previously [16].…”

The tip of antibody-testing iceberg

“…The authors indicate that most of these pregnancies in women with SPS were carried safely to term, with few or no complications for the mother or child, although 2 infants were found to harbor GAD65 antibodies. In the current issue of N2, another article by Joubert et al 4 examined the pregnancy outcomes in 32 patients with anti-NMDAR encephalitis (11 new cases and 21 previously reported). These authors found that although pregnant patients with anti-NMDAR encephalitis often had obstetrical complications, most of the newborns were healthy and seemed to have normal development.…”