Increased Neuromyelitis Optica Spectrum Disorder Relapse Risk in Postpartum Period

Neuromyelitis optica spectrum disorder (NMOSD) typically presents itself during the postpartum period and is associated with a high relapse rate during the first 3 months after pregnancy, according to a retrospective study published in Neurology.

Investigators provided patients with NMOSD (n=217) with a questionnaire to obtain clinical and pregnancy data. Using these data, the researchers compared the annual relapse rate during 2 years before the patient’s first pregnancy and 9 months postpartum.

Among 31 participants with NMOSD, a total of 46 pregnancies occurred after onset of NMOSD symptoms. The annual relapse rate was significantly increased during pregnancy (0.44; P =.035) and the postpartum period (0.69; P =.009) compared with the 2-year period before the initial pregnancy.

The first 3 months of the postpartum period were associated with the highest annual relapse rate among the cohort (1.33). Approximately 10.5% of participants who experienced NMOSD onset before the age of 40 years reported initial symptoms during the first 3 months of postpartum. A total of 10 pregnancies occurring after the onset of symptoms resulted in spontaneous abortion, whereas 2 featured a therapeutic abortion.

One limitation of this study is its retrospective design; the researchers suggest future prospective studies of acute relapse and disease-modifying treatment courses during and after pregnancy to ultimately improve treatment regimens for patients with NMOSD.

The findings of this analysis may provide the best clinical utility for “counseling patients with NMOSD regarding family planning and appropriate management of disease-modifying therapy prior to, during, and after pregnancy.”

Reference

Klawiter EC, Bove R, Elsone L, et al. High risk of postpartum relapses in neuromyelitis optica spectrum disorder . Neurology. 2017;89(22):2238-2244.