Pregnancy-related relapse risk factors in women with anti-AQP4 antibody positivity and neuromyelitis optica spectrum disorder

Shimizu, Yuko; Fujihara, Kazuo; Ohashi, Takashi; Nakashima, Ichiro; Yokoyama, Kazumasa; Ikeguch, Ryotaro; Takahashi, Toshiyuki; Misu, Tatsuro; Shimizu, Satoru; Akiyama, Masashi; Kitagawa, Kazuo

doi:10.1177/1352458515583376

Cited by 66 publications

(109 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Most of the literature reports that the ARR during pregnancy increases during the third trimester and the first trimester post-partum, while this particular case had two pregnancy-related relapses, one during the first trimester and one during the second trimester. An interesting fact is that the patient had not been receiving immunosuppressive treatment the year before becoming pregnant, which has been recently proposed as another risk factor for pregnancy-related relapses (12). As well, the present case suggests that plasma exchange therapy is a rather safe treatment option during pregnancy and could be considered for difficult or resistant cases.…”

Section: Discussionmentioning

confidence: 57%

Plasma exchange therapy for a severe relapse of Devic’s disease in a pregnant woman: A case report and concise review

Tabares

Amaya

2016

Clinical Neurology and Neurosurgery

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 57%

Plasma exchange therapy for a severe relapse of Devic’s disease in a pregnant woman: A case report and concise review

Tabares

Amaya

2016

Clinical Neurology and Neurosurgery

View full text Add to dashboard Cite

“…It has been recognized that common neuroinflammatory conditions, including MS, NMO, and myasthenia gravis (MG), have increased relapse rates in the first 3 months of the postpartum period compared with the relapse rate during pregnancy or prior to pregnancy (►Table 2). [20][21][22][23][24][25][26] Since similar observations were made in many other autoimmune conditions, 27,28 this temporal relationship between termination of pregnancy and increased disease activity is thought to reflect the loss of pregnancy-induced immunotolerance. The relapse rate in patients with MS is lower during pregnancy and reaches a nadir in the third trimester, which is a pattern recognized in several other autoimmune conditions, such as rheumatoid arthritis (RA) 29 and autoimmune hepatitis.…”

Section: Adaptive Immune Responses and Autoimmune Disease Activity Dumentioning

confidence: 78%

The Neurology of Immune-Mediated Disorders in Women

Vodopivec

2017

Semin Neurol

View full text Add to dashboard Cite

Many neuroinflammatory disorders have a predilection for women; even if there is no female predominance, neuroinflammatory conditions in women pose a management challenge for several reasons. Disease activity of these conditions may change during pregnancy and commonly increases in the postpartum period. Uncontrolled disease activity may affect pregnancy outcomes. Moreover, immunomodulating agents that are used to suppress the disease activity may have a negative impact on fertility, pregnancy, and fetal outcomes, and on infants who are breastfed. Adverse effects of immunosuppressants extend beyond the reproductive issues and may include bone loss, increased risk of cancers, and infectious complications. The successful management of women with these disorders requires that not only practitioners understand and recognize the adverse effects of immunosuppressants, but also seek to prevent adverse outcomes through counseling about contraceptive choices, safety monitoring, risk surveillance, and other strategies.

show abstract

“…[89] Next, this study summarized the sharp hormonal changes before and after childbirth that may cause newly-onset IDD during puerperium. [210]…”

Section: Discussionmentioning

confidence: 99%

Insights into Initial Demyelinating Episodes of Central Nervous System during Puerperium

Chen

Liu

et al. 2017

Chinese Medical Journal

View full text Add to dashboard Cite

Background:Inflammatory demyelinating disease of central nervous system (CNS) is an inflammatory disease characterized by a high childbearing female predominance. Labor-related alterations for postpartum demyelinating attacks are not entirely clear. This study aimed to summarize clinical features of female patients of reproductive age with initial CNS inflammatory demyelinating attacks during puerperium.Methods:Fourteen female patients with initial demyelinating events during puerperium between January 2013 and December 2016 were retrospectively studied. Records of clinical features, neuroimaging, serum antibodies, cerebrospinal fluid (CSF) findings, annualized relapse rate (ARR), and treatment were analyzed.Results:Among 14 patients, 5 patients were diagnosed with multiple sclerosis (MS), four as neuromyelitis optica (NMO), two as longitudinal extensive transverse myelitis, two as clinical isolated syndrome (CIS), and one as acute brainstem syndrome. All the 14 puerperal female patients presented with more than one manifestation of hemiplegia, paraplegia, uroschesis, visual loss or dysarthria, and with mild to moderate abnormalities of CSF. Attacks occurred during the first trimester postpartum and cesarean section was the main delivery way (n = 10). Median Expanded Disability Status Scale (EDSS) scores were 5.0 (range: 2.0–9.0) at the onset and 2.5 (range: 0–7.0) at the end of follow-ups. Patients with MS and CIS had a significantly lower EDSS scores than patients with NMO spectrum disorders (P < 0.05). Median ARR was 0.46 (range: 0–1.16); all patients had a low ARR (0.49 ± 0.34, 95% confidence interval: 0.29–0.69) with standardized treatments.Conclusion:Labor-related alterations in the mother's immune system might result in newly-onset demyelinating diseases of central nervous system.

show abstract

Pregnancy-related relapse risk factors in women with anti-AQP4 antibody positivity and neuromyelitis optica spectrum disorder

Abstract: In the present study, pregnancy-related attack was common in NMOSD, and unlike in multiple sclerosis, the ARR was not reduced during pregnancy. Discontinued or insufficient immunosuppression appeared to increase the risk of pregnancy-related attack.

Cited by 66 publications

References 30 publications

Plasma exchange therapy for a severe relapse of Devic’s disease in a pregnant woman: A case report and concise review

Plasma exchange therapy for a severe relapse of Devic’s disease in a pregnant woman: A case report and concise review

The Neurology of Immune-Mediated Disorders in Women

Insights into Initial Demyelinating Episodes of Central Nervous System during Puerperium

Contact Info

Product

Resources

About