The following is a summary of “Risks and outcomes of pregnancy in neuromyelitis optica spectrum disorder: A comprehensive review,” published in the December 2023 issue of Neurology by Siriratnam et al.

Neuromyelitis optica spectrum disorder (NMOSD) stands as a rare autoimmune condition affecting the central nervous system. This disorder is frequently associated with the Aquaporin-4 antibody (AQP4-IgG), detected in more than 75% of cases, although criteria also recognize seronegative NMOSD. Notably, AQP4-IgG NMOSD predominantly affects females, presenting at a ratio of 9:1, with a median onset typically occurring at 40. Given this gender prevalence and disease nature, the implications of pregnancy in individuals with NMOSD are of significant concern. Studies indicate a probable reduction in fertility among those with NMOSD.

Furthermore, females with NMOSD who become pregnant face heightened risks of obstetric complications, such as increased rates of miscarriages and pre-eclampsia, surpassing those observed in the general population and even in related conditions like multiple sclerosis (MS). Unlike the course observed in MS, NMOSD typically does not display a decline in disease activity during pregnancy. On the contrary, there’s a substantial escalation in the risk of relapse, surpassing pre-pregnancy rates, particularly in the early postpartum phase. Given the constantly evolving landscape of NMOSD, this review aims to offer a contemporary and comprehensive update on the repercussions of pregnancy in individuals affected by NMOSD, shedding light on the nuanced impacts and highlighting the distinctive challenges posed by this condition during pregnancy.

Source: sciencedirect.com/science/article/pii/S1568997223002331