Family planning in neuromyelitis optica spectrum disorder

Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune inflamammatory disorder of the cnetral nervous system involving maily the spinal cord and optic nerves and is charaectrized by severe relapses with a high possibilty of leaving disability behind. AQP4-IgG NMOSD has a strong female predominance with a prevalnce during the childbearing priod. NMOSD pregnancies are considered high risk with an increased risk of maternal and obstetric complications. Unlike multiple sclerosis, the pregnancy carries the risk of increasing relapse potential. Family planning in females with NMOSD is a critical issue with the lack of evidence encouraging the use of disease modifying therapies during pregnancy. This review discusses impact of NMOSD on fertility/fecundity and pregnancy, heritability, impact of pregnancy on NMOSD, family planning, treating acute relapse during pregnancy, delivery in women with NMOSD, postpartum management and breastfeeding, contraception and assisted reproduction technology, ending in a group of recommendations based on the best available evidence.