Rare demyelinating autoimmune diseases and pregnancy outcomes

Neuromyelitis optica (NMO) and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) are demyelinating autoimmune diseases that often occur in women of reproductive age. The aim of this study is to characterize pregnancy outcomes in women with NMO or MOGAD.

Retrospective chart review data were collected from four academic medical institutions in the Southeast United States using a REDCap-based tool.

Data from 59 patients representing 101 NMO and 59 MOGAD pregnancies were included. The present sample showed reduced rates of spontaneous abortion (SAB) at 6.9% in patients with NMO compared to patients with MS (17.3%, p = 0.045). Intrauterine fetal demise (IUFD) was more frequent in patients with NMO (1.98%) than in the general population (0.38%, p = 0.042). Only 10.2% of MOGAD pregnancies and 20.8% of NMO pregnancies were uncomplicated. No differences between groups existed for preeclampsia or preterm delivery. This cohort demonstrated similar rates of vaginal and cesarean delivery between groups. Relapse rates were lowest during pregnancy and highest postpartum for both groups.

Women with NMO and MOGAD had fewer spontaneous abortions than both comparison groups, but more frequent complications. Unlike prior studies evaluating MS and NMO in pregnancy, this cohort did not demonstrate higher rates of preeclampsia or preterm birth. This study observed significantly fewer relapses during pregnancy and significantly more relapses postpartum for NMO and MOGAD subgroups. Patients who received disease-modifying therapy had the fewest relapses. These data show that MOGAD and NMO have similarities with MS in terms of pregnancy outcomes but suggest differences that require tailored treatment through pregnancy.