High risk of postpartum relapses in neuromyelitis optica spectrum disorder

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Item Type:	Article
Title:	High risk of postpartum relapses in neuromyelitis optica spectrum disorder
Creators Name:	Klawiter, E.C., Bove, R., Elsone, L., Alvarez, E., Borisow, N., Cortez, M., Mateen, F., Mealy, M.A., Sorum, J., Mutch, K., Tobyne, S.M., Ruprecht, K., Buckle, G., Levy, M., Wingerchuk, D., Paul, F., Cross, A.H., Jacobs, A., Chitnis, T. and Weinshenker, B.
Abstract:	OBJECTIVE: To study the effect of pregnancy on the frequency of neuromyelitis optica spectrum disorder (NMOSD) relapse and evaluate rates of pregnancy-related complications in an international multicenter setting. METHODS: We administered a standardized survey to 217 women with NMOSD from 7 medical centers and reviewed their medical records. We compared the annualized relapse rate (ARR) during a baseline period 2 years prior to a participant's first pregnancy to that during pregnancy and to the 9 months postpartum. We also assessed pregnancy-related complications. RESULTS: There were 46 informative pregnancies following symptom onset in 31 women with NMOSD. Compared to baseline (0.17), ARR was increased both during pregnancy (0.44; p = 0.035) and during the postpartum period (0.69; p = 0.009). The highest ARR occurred during the first 3 months postpartum (ARR 1.33). A total of 8 of 76 (10.5%) with onset of NMOSD prior to age 40 experienced their initial symptom during the 3 months postpartum, 2.9 times higher than expected. CONCLUSIONS: The postpartum period is a particularly high-risk time for initial presentation of NMOSD. In contrast to published observations in multiple sclerosis, in neuromyelitis optica, relapse rate during pregnancy was also increased, although to a lesser extent than after delivery.
Keywords:	Disability Evaluation, Electronic Health Records, Immunologic Factors, Neuromyelitis Optica, Postpartum Period, Pregnancy, Pregnancy Complications, Recurrence, Risk
Source:	Neurology
ISSN:	0028-3878
Publisher:	American Academy of Neurology
Volume:	89
Number:	22
Page Range:	2238-2244
Date:	28 November 2017
Official Publication:	https://doi.org/10.1212/WNL.0000000000004681
External Fulltext:	View full text on PubMed Central
PubMed:	View item in PubMed

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