Influences of pregnancy on neuromyelitis optica spectrum disorders and multiple sclerosis

https://doi.org/10.1016/j.msard.2018.07.006Get rights and content

Highlights

  • Both neuromyelitis optica spectrum disorders (NMOSD) and multiple sclerosis (MS) patients are primarily women of childbearing age.

  • This article aimed to assess and compare the effect of pregnancy on disease progression of NMOSD and MS.

  • The study found that both NMOSD and MS presented increased onset and relapses after delivery/abortion.

  • In this study, NMOSD patients showed significant differences in annualized relapse rate (ARR) at different stages from MS.

  • The stuBoth delivery and abortion exerted detrimental effects on disease courses in NMOSD and MS.

Abstract

Objective

To assess the influences of pregnancy on disease progression of neuromyelitis optica spectrum disorders (NMOSD) and multiple sclerosis (MS).

Methods

A total of 148 NMOSD patients and 170 MS patients were reviewed retrospectively. The changes in mean annualized relapse rate (ARR) in NMOSD and MS during and after pregnancy were compared. The influences of different pregnancy outcomes on disease courses were also analyzed.

Results

Sixty-two relapses had occurred during pregnancy or within 1 year after delivery/abortion in NMOSD patients and 64 in MS patients. The proportion of pregnancy-related onset and relapse in NMOSD was not significantly higher than that in MS. The ARR during 0–3 months and 7–9 months postpartum/postabortal periods in NMOSD and during 0–3 months and 10–12 months postpartum/postabortal periods in MS increased significantly. The ARR in 7–9 months postpartum/postabortal period in NMOSD patients was significantly higher than that in MS patients. Different pregnancy outcomes affected the course of disease similarly in patients irrespective of NMOSD or MS.

Conclusions

Both NMOSD and MS presented increased onset and relapses after delivery/abortion. Significant differences were observed in ARRs at different stages between them. Both delivery and abortion exerted detrimental effects on disease courses in NMOSD and MS.

Introduction

Neuromyelitis optica spectrum disorders (NMOSD) is a rare inflammatory demyelinating disease of the central nervous system (CNS) characterized by inflammation of the optic nerve, spinal cord, and specific brain areas (Wingerchuk et al., 2015). Multiple sclerosis (MS) is another autoimmune disorder of the CNS characterized by demyelination and axonal degeneration presenting clinical features that overlapped with NMOSD. Aquaporin-4 antibody (AQP4- immunoglobulin [IgG]) is a highly specific antibody involved in the disease pathogenesis of NMOSD and provides strong evidence for distinguishing NMOSD from MS (Saikali et al., 2009, Takahashi et al., 2007, Tradtrantip et al., 2012).

In NMOSD, 70–90% affected individuals were predominantly women with an average age of 40 years at onset of the disease (Weinshenker and Wingerchuk, 2017). MS is initiated at the age of 20–40 years and the ratio of women to men is about 3:1 (Buraga and Popovici, 2014). Therefore, either NMOSD or MS patients are primarily women of childbearing age. Exhaustive literature is available on the influence of pregnancy on MS. In MS, the frequency of relapses decreases during pregnancy, especially the third trimester, but increases during the first trimester postpartum (Confavreux et al., 1998, Finkelsztejn et al., 2011). However, only limited data are available regarding pregnancy in women with NMOSD and effective comparison between the effects of pregnancy on NMOSD and MS.

In the current study, we investigated the effects of pregnancy and pregnancy outcomes on disease onset and relapse rate in Chinese female patients with NMOSD. Also, the differences between NMOSD and MS were analyzed.

Section snippets

Patients and methods

Ethics approval for the present study was obtained from the Ethics Committee of Beijing Tiantan Hospital, Capital Medical University, China (No. KY2016-052-02). Before participation in the study, all patients provided written informed consent.

Patients with NMOSD and MS were enrolled consecutively from Beijing Tiantan Hospital when attending their scheduled visit at the outpatient clinic between January 2017 and January 2018. The diagnosis of these conditions was confirmed according to the 2015

Demographics and disease characteristics

A total of 148 patients with NMOSD and 170 patients with MS were enrolled in the current study. The mean age at disease onset, disease duration, the frequency of relapses, and pregnancy information were described in Table 1. Disease duration of MS patients were significantly longer than that of NMOSD patients (P < 0.0001).

Pregnancy-related onset in NMOSD and MS patients

In NMOSD group, 128 (86.5%) patients had been pregnant for 234 times, collectively, in the past, resulting in 144 deliveries and 90 abortions. The age at first pregnancy was

Discussion

Pregnancy is known to play a modulatory role in the course of autoimmune diseases, including NMOSD and MS. In the current study, we examined and compared the influences of pregnancy on these two CNS autoimmune inflammatory disorders.

Given that 70–90% of patients with NMOSD were females of childbearing age, the effect of pregnancy on NMOSD is a controversial issue in the clinical treatment and care concerning family planning decisions of patients with NMOSD.

Pregnancy induces marked changes in

Conflicts of interest

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The present study was supported by the National Natural Science Foundation of China (CN) (81473640, 81573898, 81173237) and the Beijing Science and Technology Development Fund for Traditional Chinese Medicine (CN) (JJ2016-11).

References (21)

  • S. Brummelte et al.

    Postpartum depression: Etiology, treatment and consequences for maternal care

    Horm. Behav.

    (2016)
  • P. Saikali et al.

    Anti-aquaporin-4 auto-antibodies orchestrate the pathogenesis in neuromyelitis optica

    Autoimmun. Rev.

    (2009)
  • B.G. Weinshenker et al.

    Neuromyelitis Spectrum Disorders

    Mayo Clin. Proc.

    (2017)
  • I. Buraga et al.

    Multiple sclerosis and pregnancy: current considerations

    ScientificWorldJournal

    (2014)
  • H. Butzkueven et al.

    Efficacy and safety of natalizumab in multiple sclerosis: interim observational programme results

    J. Neurol. Neurosurg. Psychiatr.

    (2014)
  • C. Confavreux et al.

    Rate of pregnancy-related relapse in multiple sclerosis. Pregnancy in multiple sclerosis group

    N. Engl. J. Med.

    (1998)
  • V. Davoudi et al.

    Immunology of neuromyelitis optica during pregnancy

    Neurol. Neuroimmunol. Neuroinflamm.

    (2016)
  • A. Finkelsztejn et al.

    What can we really tell women with multiple sclerosis regarding pregnancy? A systematic review and meta-analysis of the literature

    BJOG

    (2011)
  • M.T. Kampman et al.

    Effect of vitamin D3 supplementation on relapses, disease progression, and measures of function in persons with multiple sclerosis: exploratory outcomes from a double-blind randomised controlled trial

    Mult. Scler.

    (2012)
  • W. Kim et al.

    Influence of pregnancy on neuromyelitis optica spectrum disorder

    Neurology

    (2012)
There are more references available in the full text version of this article.

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