Journal
EPMA JOURNAL
Volume 9, Issue 3, Pages 249-256Publisher
SPRINGER INTERNATIONAL PUBLISHING AG
DOI: 10.1007/s13167-018-0143-9
Keywords
Neuromyelitis optica; Devic's syndrome; Pregnancy; Relapse prevention; Personalized treatment
Funding
- Bayer
- Novartis
- Biogen Idec
- Teva
- Sanofi-Aventis/Genzyme
- Merck Serono
- Alexion
- Chugai
- MedImmune
- Shire
- German Research Foundation
- Werth Foundation of the city of Cologne
- German Federal Ministry of Research and Education
- Arthur Arnstein Stiftung Berlin
- EU FP7 Framework Program
- Jackson Charitable Foundation
- National Multiple Sclerosis of the USA
- Bayer Healthcare
- Biogen
- Novartis Pharma
- Teva Pharma
- Roche
- Sanofi-Genzyme
- Merck
- German Ministry for Education and Research (BMBF) as part of the German Competence Network Multiple Sclerosis (KKNMS) [FKZ 01GI1602A, FKZ 01GI1602B, FKZ 01GI1602C]
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Neuromyelitis optica spectrum disorders (NMOSD) are autoimmune inflammatory diseases of the central nervous system that predominately affect women. Some of these patients are of childbearing age at NMOSD onset. This study reviews, on the one hand, the role NMOSD play in fertility, pregnancy complications and pregnancy outcome, and on the other, the effect of pregnancy on NMOSD disease course and treatment options available during pregnancy. Animal studies show lower fertility rates in NMOSD; however, investigations into fertility in NMOSD patients are lacking. Pregnancies in NMOSD patients are associated with increased disease activity and more severe disability postpartum. Some studies found higher risks of pregnancy complications, e.g., miscarriages and preeclampsia. Acute relapses during pregnancy can be treated with methylprednisolone and/or plasma exchange/immunoadsorption. A decision to either stop or continue immunosuppressive therapy with azathioprine or rituximab during pregnancy should be evaluated carefully and factor in the patient's history of disease activity. To this end, involving neuroimmunological specialist centers in the treatment and care of pregnant NMOSD patients is recommended, particularly in specific situations like pregnancy.
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