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High risk of postpartum relapses in neuromyelitis optica spectrum disorder

Item Type:Article
Title:High risk of postpartum relapses in neuromyelitis optica spectrum disorder
Creators Name:Klawiter, E.C. and Bove, R. and Elsone, L. and Alvarez, E. and Borisow, N. and Cortez, M. and Mateen, F. and Mealy, M.A. and Sorum, J. and Mutch, K. and Tobyne, S.M. and Ruprecht, K. and Buckle, G. and Levy, M. and Wingerchuk, D. and Paul, F. and Cross, A.H. and Jacobs, A. and 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
Publisher:American Academy of Neurology
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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