Neuromyelitis optica spectrum disorders and pregnancy: Interactions and management

Eslam Shosha, Sean J. Pittock, Eoin Flanagan, Brian G. Weinshenker

Research output: Contribution to journalReview articlepeer-review

21 Scopus citations


Neuromyelitis optica spectrum disorders (NMOSD) predominantly affect women who are of childbearing age. Understanding the interactions between pregnancy and NMOSD is important for clinical management. Aquaporin-4 (AQP4), the most common target antigen in NMOSD, is expressed on placenta in early pregnancy. A variety of immune and cytokine changes in pregnancy may impact pregnancy outcomes in NMOSD patients. Relapses continue during pregnancy and increase in frequency postpartum. Preeclampsia and fetal loss are more frequent in NMOSD than in controls. Transfer of AQP4-immunoglobulin G (IgG) from mother to baby occurs but appears not to cause disease. Several treatment options are relatively safe and mitigate the risk of relapse during pregnancy and postpartum. For patients with active NMOSD, it may be advisable to continue immunotherapy during pregnancy.

Original languageEnglish (US)
Pages (from-to)1808-1817
Number of pages10
JournalMultiple Sclerosis
Issue number14
StatePublished - Dec 1 2017


  • breast feeding
  • immunosuppressive safety
  • miscarriage
  • pregnancy
  • relapse rate

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology


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