[Neuroimmunological diseases and pregnancy]

Area of Science:

• Neuroimmunology
• Reproductive Neurology
• Maternal-Fetal Medicine

Context:

• Pregnancy presents unique challenges for managing neuroimmunological conditions such as multiple sclerosis (MS), neuromyelitis optica (NMO), and myasthenia gravis (MG).
• Understanding disease behavior during pregnancy and postpartum is crucial for optimizing patient care and outcomes.
• Current management often involves medication adjustments, like discontinuing interferon-beta (IFNβ) for MS, due to potential effects on fetal development.

Purpose:

• To analyze and compare the effects of pregnancy and delivery on relapse rates and disease activity in patients with MS, NMO, and MG.
• To highlight specific risks and considerations for each neuroimmunological disease during the perinatal period.
• To inform clinical practice regarding the management of these conditions in pregnant individuals.

Summary:

• In multiple sclerosis (MS), the annual relapse rate (ARR) decreases during pregnancy and increases postpartum. Interferon-beta (IFNβ) discontinuation is common, with IFNβ exposure linked to lower birth weight but no reported fetal abnormalities.
• Neuromyelitis optica (NMO) shows a stable ARR during pregnancy, but a significant increase is observed postpartum, suggesting delivery may trigger exacerbations. Postpartum onset of NMO is also noted.
• Myasthenia gravis (MG) management during pregnancy involves variable outcomes, with exacerbations, remissions, and stable disease each occurring in about 30% of cases. Risks include exacerbations in the first trimester and postpartum, and a 10-20% risk of transient neonatal MG.

Impact:

• Provides critical insights into the pregnancy course for women with MS, NMO, and MG, aiding in personalized management strategies.
• Emphasizes the need for careful monitoring and tailored treatment plans, especially concerning postpartum relapse risks and neonatal complications.
• Contributes to evidence-based guidelines for neurologists and obstetricians managing pregnant patients with these complex neuroimmunological disorders.