Relapse Risk During the Pregnancy and Postpartum Periods in Patients With Preexisting MOG Antibody Associated Disorder: A Two-Center Retrospective Study
Angie Kim1, Olivia Pasquale2, Gabriela Romanow3, Heather Tchen3, Michael Levy4, Ilya Kister1
1Neurology, NYU Grossman School of Medicine, 2Creighton University School of Medicine, 3Massachusetts General Hospital, 4Massachusetts General Hospital/Harvard Medical School
Objective:
To calculate the rate of relapse during pregnancy and 12-month postpartum periods in women with preexisting diagnosis of myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD).
Background:
Risk of relapse is increased during the postpartum period in untreated multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD). Less is known about the risk of relapse during pregnancy and the postpartum period in women with preexisting MOGAD.
Design/Methods:
Two large MOGAD clinics at NYU Multiple Sclerosis Care Center, New York, and The Neuroimmunology Clinic at Massachusetts General Hospital, Boston, conducted retrospective chart reviews on all cases of neuroimmunologist-diagnosed MOGAD and identified all pregnancies that occurred after MOGAD onset. Relevant demographic, neurologic, and obstetrical data were extracted from the charts, with special attention to pregnancy/postpartum periods.
Results:
Sixteen women with MOGAD experienced a total of 22 pregnancies after disease onset. Mean age at first post-MOGAD onset pregnancy was 30.9 ± 4.1 years, and mean disease duration at first pregnancy was 8.37 ± 5.7 years. None of the patients (0%) experienced a neurologist-confirmed relapse during pregnancy. One patient (6.3%) experienced two relapses of optic neuritis 3 weeks and 7 months postpartum while on low-dose prednisone. For 13/22 pregnancies, patients were on a disease modifying therapy (DMT) at the time of conception and 7/22 continued DMT throughout pregnancy. In 8/22 pregnancies, a DMT was started during the postpartum period; 6 of which were started within 2 months after giving birth. Sixteen of 22 pregnancies were carried to term, 2 of 22 are ongoing. Three pregnancies not carried to term were a result of termination, ectopic pregnancy, and miscarriage. Complications during pregnancy or delivery were recorded for 9/22 pregnancies.
Conclusions:
Preliminary data suggests that relapse during pregnancy/postpartum is rare in women with MOGAD. However, many patients were on a DMT during pregnancy/postpartum, which may have lowered the relapse risk.
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