Neuromyelitis Optica Spectrum Disorders and Pregnancy Implications

Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune astrocytopathy characterised by recurrent optic neuritis and longitudinally extensive transverse myelitis. Predominantly affecting women of childbearing age, NMOSD often follows a more severe course than multiple sclerosis, with cumulative disability driven by each relapse. Pregnancy does not confer the same immunomodulatory benefit observed in multiple sclerosis; disease activity may persist or even worsen during gestation and rises sharply in the early postpartum period. Obstetric complications such as miscarriage, pre-eclampsia and preterm delivery occur at higher rates than in the general population, while foetal growth restriction and congenital anomalies remain uncommon. Optimal management requires balancing relapse prevention with foetal safety, utilising agents such as corticosteroids, azathioprine or monoclonal antibodies under close monitoring. Emerging data on agents targeting interleukin-6 and complement pathways offer new options for perinatal care, while multidisciplinary collaboration among neurology, obstetrics and neonatology is vital. Prospective international registries and standardised protocols are essential to refine counselling, reduce maternal and foetal risks and guide personalised treatment strategies.

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Neuromyelitis Optica Spectrum Disorders and Pregnancy Implications publication trend

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Technical terms

Aquaporin-4 antibody (AQP4-IgG): Autoantibody directed against the main water channel protein in astrocytes, diagnostic of NMOSD.

Myelin oligodendrocyte glycoprotein antibody (MOG-IgG): Autoantibody targeting a minor myelin protein, associated with a distinct demyelinating syndrome overlapping with NMOSD.

Postpartum relapse: A clinical attack occurring within three months after delivery, reflecting a rebound in disease activity.

Pre-eclampsia: Pregnancy-associated hypertensive disorder characterised by new-onset hypertension and organ dysfunction, observed at higher frequency in NMOSD.

Immunosuppressive therapy: Pharmacological agents (e.g. azathioprine, corticosteroids, monoclonal antibodies) used to prevent autoantibody-mediated inflammation in NMOSD.

References

1. Risks and outcomes of pregnancy in neuromyelitis optica spectrum disorder: A comprehensive review. Autoimmunity Reviews (2023).
2. Pregnancy and Neuromyelitis Optica Spectrum Disorder – Reciprocal Effects and Practical Recommendations: A Systematic Review. Frontiers in Neurology (2020).
3. Pregnancy-Related Attack in Neuromyelitis Optica Spectrum Disorder With AQP4-IgG: A Single-Center Study and Meta-Analysis. Frontiers in Immunology (2022).
4. Neuromyelitis optica spectrum disorder safely and successfully treated with satralizumab during pregnancy and breastfeeding: a case report. Frontiers in Neurology (2023).