title: Neuromyelitis optica and pregnancy.
abstract: OBJECTIVE
  The purpose of our study was to assess the influence of pregnancy on the course of neuromyelitis optica (NMO) and the impact of epidural analgesia and breastfeeding on its activity in the postpartum period.
  
  
  METHODS
  We performed a retrospective study of patients with NMO diagnosed according to Wingerchuk criteria. We noted the number of relapses during the year before pregnancy (BP), during pregnancy (first trimester, second trimester, third trimester), and the year after (Y + 1: first trimester, second trimester [PP2], and third and fourth trimesters postpartum). Epidural analgesia and breastfeeding were recorded. Disability was evaluated with the Kurtzke Expanded Disability Status Scale (EDSS). The annualized relapse rate (ARR) was calculated.
  
  
  RESULTS
  We identified 124 patients (85 female) in the French NOMADMUS cohort on November 1, 2010. A total of 20 women (including 25 pregnancies) were informative with complete files. Comparisons between the ARR of each period and BP (1.0 ± 0.09) only showed an increased tendency for PP2 (0.8 ± 0.06, p = 0.07). Epidural analgesia and breastfeeding had no influence on the course of NMO. The EDSS score increased from 1.5 ± 1.7 BP to 2.6 ± 1.9 Y + 1 (p = 0.027).
  
  
  CONCLUSIONS
  This study shows that pregnancy influences the activity of NMO, a finding that justifies close medical monitoring. We found no evidence to suggest that either epidural analgesia or breastfeeding has an aggravating effect on NMO.
authors.affiliation: Department of Neurology, Hôpital Charles Nicolle, Rouen, France. bertrand.bourre@chu-rouen.fr
authors.forename: B
authors.initials: B
authors.lastname: Bourre
authors.forename: R
authors.initials: R
authors.lastname: Marignier
authors.forename: H
authors.initials: H
authors.lastname: Zéphir
authors.forename: C
authors.initials: C
authors.lastname: Papeix
authors.forename: D
authors.initials: D
authors.lastname: Brassat
authors.forename: G
authors.initials: G
authors.lastname: Castelnovo
authors.forename: N
authors.initials: N
authors.lastname: Collongues
authors.forename: S
authors.initials: S
authors.lastname: Vukusic
authors.forename: P
authors.initials: P
authors.lastname: Labauge
authors.forename: O
authors.initials: O
authors.lastname: Outteryck
authors.forename: B
authors.initials: B
authors.lastname: Fontaine
authors.forename: P
authors.initials: P
authors.lastname: Vermersch
authors.forename: C
authors.initials: C
authors.lastname: Confavreux
authors.forename: J
authors.initials: J
authors.lastname: de Seze
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural; D016362:Analgesia, Obstetrical; D001942:Breast Feeding; D015331:Cohort Studies; D016208:Databases, Factual; D004185:Disability Evaluation; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007074:Immunoglobulin G / Q000032:analysis; D008279:Magnetic Resonance Imaging; D009471:Neuromyelitis Optica / Q000453:epidemiology / Q000473:pathology*; D049590:Postpartum Period; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000473:pathology*; D011264:Pregnancy Trimesters; D012008:Recurrence; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D007074:Immunoglobulin G