title: Pregnancy in neuromyelitis optica spectrum disorder: A multicenter study from South China.
abstract: OBJECTIVE
  This study aimed to assess the effect of pregnancy on the course of neuromyelitis optica spectrum disorder (NMOSD), and the effect of this disease on pregnancy outcomes.
  
  
  METHODS
  Consecutive patients with NMOSD were recruited between September 2015 and April 2016 at an outpatient clinic from four referral institutes in South China. Demographic, clinical, and pregnancy data were retrieved by questionnaires to analyze the association between NMOSD and pregnancy, as well as the potential risk factors for relapse.
  
  
  RESULTS
  Among 249 patients with NMOSD, 55 had pregnancy-related attacks. The annual relapse rate in the first (3.20±6.82) and second (3.25±3.32) 3-month postpartum periods was marginally higher than that before pregnancy (1.44±0.92, p=0.682) and during pregnancy (1.23±1.32, p=0.758). The Kurtzke Expanded Disability Status Scale score increased from 1.55±0.38 before pregnancy to 2.88±2.14 at postpartum (p<0.001). NMOSD significantly increased the premature birth rate in patients after disease onset (8.33%) compared with before disease onset (1.95%, p=0.025). Multivariate analysis showed that negative anti-aquaporin-4 IgG, concomitance with autoimmune diseases/antibodies, and no treatment in remission were risk factors of recurrence.
  
  
  CONCLUSIONS
  Our study shows a significant association between pregnancy and NMOSD in the Chinese population. Larger scale prospective studies are warranted in the future.
authors.affiliation: Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors.forename: Yanlu
authors.initials: Y
authors.lastname: Huang
authors.affiliation: Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors.forename: Yuge
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors.forename: Yifan
authors.initials: Y
authors.lastname: Zhou
authors.affiliation: Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Department of Neurology, Zhaoqing No. 2 People's Hospital, Guangzhou, China.
authors.forename: Qiao
authors.initials: Q
authors.lastname: Huang
authors.affiliation: Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors.forename: Xiaobo
authors.initials: X
authors.lastname: Sun
authors.affiliation: Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors.forename: Chen
authors.initials: C
authors.lastname: Chen
authors.affiliation: Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors.forename: Ling
authors.initials: L
authors.lastname: Fang
authors.affiliation: Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
authors.forename: Youming
authors.initials: Y
authors.lastname: Long
authors.affiliation: State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Yang
authors.affiliation: Department of Neurology, Nanfang Hospital of Nanfang Medical University, Guangzhou, China.
authors.forename: Honghao
authors.initials: H
authors.lastname: Wang
authors.affiliation: School of Mathematics and Computational Science, Sun Yat-sen University, Guangzhou, China.
authors.forename: Caixia
authors.initials: C
authors.lastname: Li
authors.affiliation: Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors.forename: Zhengqi
authors.initials: Z
authors.lastname: Lu
authors.affiliation: Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors.forename: Xueqiang
authors.initials: X
authors.lastname: Hu
authors.affiliation: Centre for Neuromuscular and Neurological Disorders, University of Western Australia, Department of Neurology, Sir Charles Gairdner Hospital, Queen Elizabeth II Medical Centre, Perth, Australia; Institute of Immunology and Infectious Diseases, Murdoch University, Perth, Australia.
authors.forename: Allan G
authors.initials: AG
authors.lastname: Kermode
authors.affiliation: Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. Electronic address: qw9406@gmail.com.
authors.forename: Wei
authors.initials: W
authors.lastname: Qiu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D051401:Aquaporin 4 / Q000276:immunology; D001323:Autoantibodies / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000378:metabolism; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009471:Neuromyelitis Optica / Q000453:epidemiology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D047928:Premature Birth / Q000453:epidemiology; D012008:Recurrence; D012307:Risk Factors; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: C496030:AQP4 protein, human; D051401:Aquaporin 4; D001323:Autoantibodies; D007074:Immunoglobulin G
keywords: Neuromyelitis optica spectrum disorder; Pregnancy