Decreased Risk for Neuromyelitis Optica Spectrum Disorder Relapse During Pregnancy

An expecting mother holding her stomach in the park
Study researchers sought to assess the effects of pregnancy on relapse pattern in patients with neuromyelitis optica spectrum disorder.

Women with neuromyelitis optica spectrum disorder (NMOSD) exhibited a pattern of decreased relapse during pregnancy; additionally, relapse rebound was higher during the preliminary postpartum period than pregnancy in patients with aquaporin-4 (AQP4) antibodies (Ab). These findings, from a retrospective, multicenter, international study, were published in Neurology.

Study researchers assessed patients (N=58) who had NMOSD and at least 1 pregnancy (n=89) treated at 7 hospitals located in France, Portugal, or the United Kingdom were assessed for AQP4-Ab and myelin oligodendrocyte glycoprotein (MOG)-Ab positivity.

The women were AQP4-Ab-positive (51.5%), MOG-Ab-positive (34%), or double negative (14.5%). NMOSD onset occurred at a mean age of 27 (standard deviation [SD], ±7.0) years and delivery occurred at a mean age of 30 (SD, ±4.9) years. Patients who were AQP4-Ab-positive tended to have more coexisting autoimmune diseases (43%) than MOG-Ab-positive (30%) or double negative (10%) women (P =.18) and were statistically more likely to miscarry (20% vs 3% vs 0%, respectively; P =.05).

The most frequently observed relapses were unilateral optic neuritis (46%) and myelitis (32%). Patient groups differed on relapse type, in which AQP4-Ab-positive patients most frequently relapsed with myelitis or optic neuritis (47% and 44%%, respectively; P =.05) and MOG-Ab-positive patients with optic neuritis (70%). AQP4-Ab (97%) or MOG-Ab (89%) positive patients more often presented with monofocal relapses. Contrastingly, double-negative patients presented more often with monofocal (56%) or bifocal relapses (33%).

Stratified by time period, relapses were more likely to occur during postpartum trimester 1 for patients who were AQP4-Ab-positive (P <.01) and during postpartum trimester 2 for double negative patients. Significant relapse reductions were observed during pregnancy compared with before conception among all women (P <.01).

Stratified by pregnancies on or off immunosuppressive therapy use, more of the AQP4-Ab-positive cohort used medication (13 vs 7) than either MOG-Ab-positive (1 vs 8) or double negative (3 vs 4) groups (P =.02). Annualized relapse rate (ARR) was increased among patients off medication (0.33; standard deviation [SD], 0.58) than on (0.19; SD, 0.47; P =.04). Among patients who were AQP4-Ab-positive, ARR was increased among patients off medication (0.62; SD, 0.74) compared with on medication (0.24; SD, 0.51; P =.02).

This study was limited by its low sample sizes especially among subgroups.

Patients who had NMOSD were at increased risk for relapse during the initial postpartum months. Relapse risk was decreased among patients who received immunosuppressive therapy during or before pregnancy, particularly among those who were AQP4-Ab-positive.

Disclosure: Multiple authors declared affiliations with the pharmaceutical industry. Please refer to the original article for a full list of disclosures.


Collongues N, Do Rego CA, Bourre B, et al. Pregnancy in Patients With AQP4-Ab, MOG-Ab, or Double-Negative Neuromyelitis Optica Disorder. Neurology. 2021;96(15):e2006-e2015. doi:10.1212/WNL.0000000000011744