Pregnancy among women with neuromyelitis optica spectrum disorder: An updated case series from Iran

Neuromyelitis Optica spectrum disorder (NMOSD) is primarily afflicted on women during their reproductive ages and complicates multiple aspects of their pregnancies.

To provide an updated assessment of conception attempts and pregnancy outcomes in a Middle Eastern group of women with NMOSD.

Retrospective observational study including all female NMOSD referrals of the Isfahan MS clinic from 1998 to 2024. Those with definitive diagnosis and attempting conception from one year before their NMOSD onset onwards were deemed eligible. Methodical history taking and medical records at the clinic were used to gather information on clinical characteristics, pregnancy history, and demographics. Fecundity, pregnancy complication(s) and outcome, neonatal health status, and clinical markers of disease status (relapse rate and disability worsening) were among the outcomes.

31 pregnancies were reported in 18 participants from a year before NMOSD onset onwards, 15 (48.4%) of which led to live childbirth. All pregnancies were conceived under 12 months, except for one (3.2%). Eight of these 18 participants also reported 12 pregnancies more than a year before their NMOSD onset, with eight (66.7%) leading to live childbirth. In this subgroup (n = 8), regression analysis revealed a significant negative effect of NMOSD onset on live childbirth (miscarriage OR = 4.41; 95% CI: 1.11, 17.54; p = 0.035). Gestational hypertension and/or preeclampsia (26.7%), late preterm labor (6.7%), and intrauterine growth restriction (13.3%) complicated post-NMOSD pregnancies, yet, no stillbirths and/or neonatal complications were reported. Although not achieving statistical significance (p values > 0.05), a trend towards higher relapse rate was observed both during and after pregnancy. Four participants further experienced EDSS worsening one year postpartum. Unintentional rituximab exposure during the first trimester of one pregnancy was associated with no maternal, fetal or neonatal complications.

In line with prior evidence from other regions, the present study revealed high occurrence rate of certain adverse pregnancy outcomes in Iranian women with NMOSD. Findings emphasize the necessity of close monitoring of pregnancies in women with NMOSD, and could pave the way for better management of NMOSD during pregnancy.