An association between pregnancy and onset or relapse of attacks in patients with neuromyelitis optica spectrum disorder (NMOSD) was found, as published in Frontiers in Immunology.

Most (69.7%) patients experienced at least 1 pregnancy-related NMOSD attack, which mainly occurred during the first trimester of the postpartum period (65.6%).

Moreover, the results of the study suggested that patients who become pregnant after NMOSD onset were more prone to lesions in the optic nerve than patients diagnosed with NMOSD during pregnancy or within 1 year after delivery or abortion.


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On the other hand, acute encephalic lesions were more commonly found in patients diagnosed with NMOSD during pregnancy or within 1 year after delivery or abortion. The occurrence of pregnancy-related NMOSD attacks was greatly reduced whenever immunosuppressive therapy was maintained during pregnancy.

“Maintenance of [immunosuppressive] therapy during pregnancy and after delivery or abortion can reduce the risk of relapse; however, it can also increase the incidence of unhealthy newborns,” the authors said.

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To better explore this issue, the authors conducted a meta-analysis. The results supported the positive impact of immunosuppressive therapy in reducing the relapse rate of NMOSD during pregnancy, with no adverse effect on the miscarriage rate. However, a 3.73 times higher number of unhealthy newborns was observed among those receiving immunosuppressive therapy.

The study included 34 pregnancies from 33 patients diagnosed with aquaporin-4 (AQP4) antibody-positive NMOSD. Half of the patients were diagnosed with NMOSD during pregnancy or within 1 year postpartum, while the other half were pregnant after NMOSD onset.

“The onset of NMOSD during pregnancy may result from immunological changes occurring during pregnancy, which may stimulate the production of AQP4-[antibodies],” the authors said.

Reference

Deng S, Lei Q, Lu W. Pregnancy-related attack in neuromyelitis optica spectrum disorder with AQP4-IgG: a single-center study and meta-analysis. Front Immunol. 2022;12. doi:10.3389/fimmu.2021.800666