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Neuromyelitis optica and pregnancy-puerperal cycle

      Highlights

      • Annualized relapses rates presented a significant increase in puerperal period.
      • Annualized relapses rates during pregnancy remains similar to the pre gestational period.
      • Significant worsening in disability was seen after 1 year of gestation.
      • No greater chance of miscarriage was seen in neuromyelitis optic patients.
      • Immunoglobulin at childbirth may be recommended, as a protect from events in the puerperium.

      Abstract

      Introduction

      Since neuromyelitis optic is a disease associated with humoral immunity (Th2), it is speculated that the pregnancy period is associated with increased relapses of the disease, as well as the presence of aquaporin 4 in the placental tissue, could lead to gestational loss. The aim of this study is to evaluate the influence of the puerperal pregnancy cycle on the course of NMO.

      Methods

      Interviewed women with gestation after diagnosis of optic neuromyelitis and submitted to questionnaires with data on the disease, such as annualized rate of relapses and EDSS score before, during and after gestation. Gestational complications were also investigated.

      Results and discussion

      19 women with 30 pregnancies. In only 8 pregnancies, there were no relapses up to 1 year postpartum, some associated with the use of immunosuppressants and/or human immunoglobulin in immediate delivery. Annualized relapses rates stood out in the puerperal period, especially in the first 3 months postpartum, in relation to before- pregnancy ARR. It was observed that pregnancy also increased functional disability in these women. Gestational complications such as miscarriage have not been shown to be more frequent in pregnant women with NMO than in the general population.

      Keywords

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