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.

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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.

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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.”


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