Pregnancy-related relapse risk factors in women with anti-AQP4 antibody positivity and neuromyelitis optica spectrum disorder.
Few reports describe the influence pregnancy has on the annualized relapse rate (ARR) in neuromyelitis optica spectrum disorder (NMOSD).



To examine pregnancy-related attacks (attacks during pregnancy or within 1 year postpartum) and identify the risk factors for an attack in Japanese NMOSD patients.



We retrospectively reviewed 139 Japanese women whom had aquaporin-4 (AQP4) antibody-positive NMOSD. Among the 114 patients with information, 47 women had 56 pregnancies. We compared the ARR before, during and after pregnancy.



Of the 47 NMOSD patients with pregnancy, 22 women (46.8%) had a pregnancy-related attack of the disease (either an onset event or a relapse). The ARR was significantly higher in the first 3 months postpartum (1.80 ± 2.04), than before the pregnancy (0.57 ± 1.16; p = 0.0043) and did not significantly decrease during pregnancy. The ARR before hospitalization and treatment was analyzable in 55 patients without pregnancy and was 1.09 ± 1.17. Among the 11 patients with onset before pregnancy, nine patients had a pregnancy-related attack with a relapse in the previous year, and their immunosuppression was discontinued or made to be at low doses; while the two patients on higher-dose therapies were relapse-free.



In the present study, pregnancy-related attack was common in NMOSD, and unlike in multiple sclerosis, the ARR was not reduced during pregnancy. Discontinued or insufficient immunosuppression appeared to increase the risk of pregnancy-related attack.
Department of Neurology, Tokyo Women's Medical University, Tokyo, Japan yshimizu@nij.twmu.ac.jp.
Yuko
Y
Shimizu
Department of Multiple Sclerosis Therapeutics, Graduate School of Medicine, Tohoku University, Sendai, Japan.
Kazuo
K
Fujihara
Department of Neurology, Tokyo Women's Medical University, Tokyo, Japan.
Takashi
T
Ohashi
Department of Neurology, Graduate School of Medicine, Tohoku University, Sendai, Japan.
Ichiro
I
Nakashima
Department of Neurology, Juntendo University, Tokyo, Japan.
Kazumasa
K
Yokoyama
Department of Neurology, Tokyo Women's Medical University, Tokyo, Japan.
Ryotaro
R
Ikeguch
Department of Multiple Sclerosis Therapeutics, Graduate School of Medicine, Tohoku University, Sendai, Japan.
Toshiyuki
T
Takahashi
Department of Multiple Sclerosis Therapeutics, Graduate School of Medicine, Tohoku University, Sendai, Japan.
Tatsuro
T
Misu
Medical Research Institute, Tokyo Women's Medical University, Tokyo, Japan.
Satoru
S
Shimizu
Department of Neurology, Graduate School of Medicine, Tohoku University, Sendai, Japan.
Masashi
M
Aoki
Department of Neurology, Tokyo Women's Medical University, Tokyo, Japan.
Kazuo
K
Kitagawa
D000328:Adult; D051401:Aquaporin 4 / Q000276:immunology*; D001323:Autoantibodies / Q000276:immunology*; D005260:Female; D006801:Humans; D007564:Japan; D009471:Neuromyelitis Optica / Q000276:immunology*; D049590:Postpartum Period; D011247:Pregnancy; D011248:Pregnancy Complications / Q000276:immunology*; D012008:Recurrence; D012189:Retrospective Studies; D055815:Young Adult
C496030:AQP4 protein, human; D051401:Aquaporin 4; D001323:Autoantibodies
Anti-aquaporin-4 antibody; immunosuppression; immunosuppressive drugs; neonates; neuromyelitis optica; neuromyelitis optica spectrum disorders; pregnancy; recurrence; relapse rate; risk factors