Nina Blum1, Karen Dost-Kovalsky1, Sina Roettger1, Saskia Wenzel1, Sabrina Haben1, Nadine Bast1, Kaya Bayer1, Achim Berthele2, Tania Kuempfel3, Marius Ringelstein4, Orhan Aktas4, Brigitte Wildemann5, Veit Rothhammer6, Yavor Yalachkov7, Martin Weber8, Luisa Klotz9, Martin Hümmert10, Friedemann Paul11, Jasmin Naumann12, Marina Herwerth13, Vivien Häußler14, Ilya Ayzenberg1, Sandra Thiel1, Kerstin Hellwig1
1Department of Neurology, St. Josef Hospital, Ruhr University, Bochum, Germany, 2School of Medicine, Technical University Munich, Klinikum rechts der Isar, 3Institute of Clinical Neuroimmunology, LMU University Hospital, LMU Munich, 4Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany, 5University Hospital Heidelberg, Department of Neurology, 6Department of Neurology, University Hospital Erlangen-Nuernberg, 7Department of Neurology, University Medicine Frankfurt, Goethe University Frankfurt, Frankfurt, Germany, 8Department of Neurology, University Medical Center Göttingen, 9Department of Neurology, University Hospital Münster, 10Department of Neurology, Medizinische Hochschule Hannover, 11Department of Neurology, ChariteBerlin, 12Department of Neurology, Knappschaft Kliniken Sulzbach, Sulzbach, Germany, 13Department of Neurology, University Hospital Zurich, 14Department of Neurology, University Medical Centre Hamburg-Eppendorf (UKE)
Objective:
To assess pregnancy outcomes and disease activity in women with NMOSD/MOGAD
Background:
Pregnancy information in women with neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is scarce
Design/Methods:
66 pregnancies were documented in the German multiple sclerosis and pregnancy registry and the neuromyelitis optica study group registry. 34 pregnancies were collected prospectively and 32 reprospectively with standardized questionnaires during pregnancy and postpartum. Clinical data including relapses and adverse pregnancy outcomes were retrieved from the registries/treating physicians
Results:
Most women 44 (66.7%) were aquaporin-4 antibody positive (AQP4-Ab+), 2 (3.0%) AQP4-Ab negative (AQP4-Ab-) and 20 (30.3%) had MOGAD with a mean age of 31.4±5.2 years. 47/64 women (73.4%; n=30 AQP4-Ab+,n=2 AQP4-Ab-, n=15 MOGAD) were therapy exposed at conception: 31/64 (48.4%) to anti-CD20, 10/64 (15.6%) to azathioprine, 2/64 (3.1%) to glatirameracetate and one each (1.6%) to satralizumab, inebilizumab and tocilizumab.
In 63 known pregnancy outcomes (n=1 ongoing, n=2 lost to follow-up), 56 live births (88.9%) with a mean birthweight of 3311 (±501.7) grams, five (7.9%) spontaneous abortions and two (3.2%) elective abortions were reported. Three (5.4%) major congenital malformations occurred: peripheral pulmonary stenosis, persistent ductus arteriosus and osteogenesis imperfecta. Excluding two infants with missing data, 6/54 (11.1%) were preterm and 10/54 (18.5%) small for gestational age (SGA).
Only 4/63 (6.3%) relapses during pregnancy (DMT untreated and AQP4+) occurred. In patients with at least three-months follow-up, 14/56 (25.0%) relapsed in the first-year postpartum (n=7/36 (19.4%) AQP4-Ab+: 1/7 (14.3%) pretreated with azathioprine, 3/7 (42.9%) with rituximab and 3/7 (42.9%) untreated; n=7/18 (38.9%) MOGAD: 1/7 (14.3%) pretreated with azathioprine, 3/7 (42.9%) with rituximab and 3/7 (42.9%) untreated). Results will be stratified by disease for the meeting
Conclusions:
Our findings provide valuable insights into pregnancies in women with NMOSD/MOGAD, with low disease activity in pregnancy and increase postpartum. Newborns were generally healthy with increased number of SGA
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