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Published on: April 14, 2014
High risk of postpartum relapses in neuromyelitis optica spectrum disorder
Eric C Klawiter1, Riley Bove2, Liene Elsone2
1From Massachusetts General Hospital (E.C.K., F.M., S.M.T.) and Brigham and Women's Hospital (R.B., G.B., T.C.), Harvard Medical School, Boston; University of California (R.B.), San Francisco; Walton Centre for Neurology and Neurosurgery and University of Liverpool (L.E., K.M., A.J.), UK; Washington University in St. Louis (E.A., A.H.C.), MO; University of Colorado School of Medicine (E.A.), Aurora; Charité-Universitätsmedizin Berlin (N.B., K.R., F.P.), Germany; Mayo Clinic (M.C., D.W.), Scottsdale, AZ; University of Utah (M.C.), Salt Lake City; Johns Hopkins University School of Medicine (F.M., M.A.M., M.L.), Baltimore, MD; Mayo Clinic (J.S., B.W.), Rochester, MN; Shepherd Center in Atlanta (G.B.), GA. eklawiter@partners.org.
Objective:
To study the effect of pregnancy on the frequency of neuromyelitis optica spectrum disorder (NMOSD) relapse and evaluate rates of pregnancy-related complications in an international multicenter setting.
Methods:
We administered a standardized survey to 217 women with NMOSD from 7 medical centers and reviewed their medical records. We compared the annualized relapse rate (ARR) during a baseline period 2 years prior to a participant's first pregnancy to that during pregnancy and to the 9 months postpartum. We also assessed pregnancy-related complications.
Results:
There were 46 informative pregnancies following symptom onset in 31 women with NMOSD. Compared to baseline (0.17), ARR was increased both during pregnancy (0.44; p = 0.035) and during the postpartum period (0.69; p = 0.009). The highest ARR occurred during the first 3 months postpartum (ARR 1.33). A total of 8 of 76 (10.5%) with onset of NMOSD prior to age 40 experienced their initial symptom during the 3 months postpartum, 2.9 times higher than expected.
Conclusions:
The postpartum period is a particularly high-risk time for initial presentation of NMOSD. In contrast to published observations in multiple sclerosis, in neuromyelitis optica, relapse rate during pregnancy was also increased, although to a lesser extent than after delivery.
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