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Influences of pregnancy on neuromyelitis optica spectrum disorders and multiple sclerosis

  • Yanping Tong
    Affiliations
    Department of Traditional Chinese Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

    Beijing Integrative medicine on Encephalopathy Research Institution, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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  • Jie Liu
    Affiliations
    Zibo Hospital of Integrated Chinese and Western Medicine, Zibo, Shandong, China
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  • Tao Yang
    Affiliations
    Department of Traditional Chinese Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

    Beijing Integrative medicine on Encephalopathy Research Institution, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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  • Yuezhi Kang
    Affiliations
    Department of Traditional Chinese Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

    Beijing Integrative medicine on Encephalopathy Research Institution, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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  • Jingwen Wang
    Affiliations
    First Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
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  • Tianyou Zhao
    Affiliations
    Department of Traditional Chinese Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

    Beijing Integrative medicine on Encephalopathy Research Institution, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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  • Cuicui Cheng
    Affiliations
    First Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
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  • Yongping Fan
    Correspondence
    Corresponding author at: Department of Traditional Chinese Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
    Affiliations
    Department of Traditional Chinese Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

    Beijing Integrative medicine on Encephalopathy Research Institution, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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      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.

      Keywords

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      References

        • Brummelte S.
        • Galea L.A.
        Postpartum depression: Etiology, treatment and consequences for maternal care.
        Horm. Behav. 2016; 77: 153-166
        • Buraga I.
        • Popovici R.E.
        Multiple sclerosis and pregnancy: current considerations.
        ScientificWorldJournal. 2014; 2014513160
        • Butzkueven H.
        • Kappos L.
        • Pellegrini F.
        • Trojano M.
        • Wiendl H.
        • Patel R.N.
        • et al.
        Efficacy and safety of natalizumab in multiple sclerosis: interim observational programme results.
        J. Neurol. Neurosurg. Psychiatr. 2014; 85: 1190-1197
        • Confavreux C.
        • Hutchinson M.
        • Hours M.M.
        • Cortinovis-Tourniaire P.
        • Moreau T.
        Rate of pregnancy-related relapse in multiple sclerosis. Pregnancy in multiple sclerosis group.
        N. Engl. J. Med. 1998; 339: 285-291
        • Davoudi V.
        • Keyhanian K.
        • Bove R.M.
        • Chitnis T.
        Immunology of neuromyelitis optica during pregnancy.
        Neurol. Neuroimmunol. Neuroinflamm. 2016; 3: e288
        • Finkelsztejn A.
        • Brooks J.B.
        • Paschoal F.M.
        • Fragoso Y.D.
        What can we really tell women with multiple sclerosis regarding pregnancy? A systematic review and meta-analysis of the literature.
        BJOG. 2011; 118: 790-797
        • Kampman M.T.
        • Steffensen L.H.
        • Mellgren S.I.
        • Jørgensen L.
        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; 18: 1144-1151
        • Kim W.
        • Kim S.H.
        • Nakashima I.
        • et al.
        Influence of pregnancy on neuromyelitis optica spectrum disorder.
        Neurology. 2012; 78: 1264-1267
        • Klawiter E.C.
        • Bove R.
        • Elsone L.
        • et al.
        High risk of postpartum relapses in neuromyelitis optica spectrum disorder.
        Neurology. 2017; 89: 2238-2244
        • Polman C.H.
        • Reingold S.C.
        • Banwell B.
        • et al.
        Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria.
        Ann. Neurol. 2011; 69: 292-302
        • Ringelstein M.
        • Harmel J.
        • Distelmaier F.
        • et al.
        Neuromyelitis optica and pregnancy during therapeutic B cell depletion: infant exposure to anti-AQP4 antibody and prevention of rebound relapses with low-dose rituximab postpartum.
        Mult. Scler. 2013; 19: 1544-1547
        • Saikali P.
        • Cayrol R.
        • Vincent T.
        Anti-aquaporin-4 auto-antibodies orchestrate the pathogenesis in neuromyelitis optica.
        Autoimmun. Rev. 2009; 9: 132-135
        • Shimizu Y.
        • Fujihara K.
        • Ohashi T.
        • et al.
        Pregnancy-related relapse risk factors in women with anti-AQP4 antibody positivity and neuromyelitis optica spectrum disorder.
        Mult. Scler. 2016; 22: 1413-1420
        • Sicotte N.L.
        • Liva S.M.
        • Klutch R.
        • et al.
        Treatment of multiple sclerosis with the pregnancy hormone estriol.
        Ann. Neurol. 2002; 52: 421-428
        • Soldan S.S.
        • Alvarez R.A.I.
        • Sicotte N.L.
        • Voskuhl R.R.
        Immune modulation in multiple sclerosis patients treated with the pregnancy hormone estriol.
        J. Immunol. 2003; 171: 6267-6274
        • Spence R.D.
        • Hamby M.E.
        • Umeda E.
        • et al.
        Neuroprotection mediated through estrogen receptor-alpha in astrocytes.
        Proc. Natl. Acad. Sci. U S A. 2011; 108: 8867-8872
        • Takahashi T.
        • Fujihara K.
        • Nakashima I.
        • et al.
        Anti-aquaporin-4 antibody is involved in the pathogenesis of NMO: a study on antibody titre.
        Brain. 2007; 130: 1235-1243
        • Tradtrantip L.
        • Zhang H.
        • Saadoun S.
        • et al.
        Anti-aquaporin-4 monoclonal antibody blocker therapy for neuromyelitis optica.
        Ann. Neurol. 2012; 71: 314-322
        • Trowsdale J.
        • Betz A.G.
        Mother's little helpers: mechanisms of maternal-fetal tolerance.
        Nat. Immunol. 2006; 7: 241-246
        • Weinshenker B.G.
        • Wingerchuk D.M.
        Neuromyelitis Spectrum Disorders.
        Mayo Clin. Proc. 2017; 92: 663-679
        • Wingerchuk D.M.
        • Banwell B.
        • Bennett J.L.
        • et al.
        International consensus diagnostic criteria for neuromyelitis optica spectrum disorders.
        Neurology. 2015; 85: 177-189