Pregnancy Outcomes and Disease Course in NMOSD and MOGAD in CANOPTICS
Laura Chu1, Dalia Rotstein1, Mark Freedman2, Andrea Konig1, Liesly Lee3, Ruth-Ann Marrie4, Jennifer McCombe5, Sarah Morrow6, Natalie Parks7, Penelope Smyth5, Kristen Krysko1
1St. Michael's Hospital, 2University of Ottawa, 3Sunnybrook Health Sciences Centre, 4University of Manitoba, 5University of Alberta, 6London Health Sciences Centre, 7Dalhousie University
Objective:

To assess pregnancy and disease outcomes in patients with aquaporin-4-positive (AQP+) NMOSD, seronegative (AQP4-/MOG-) NMOSD, and MOGAD.

Background:

There is evidence that the risk for adverse pregnancy outcomes is higher in NMOSD/MOGAD, and disease activity may increase during pregnancy and postpartum.

Design/Methods:

CANOPTICS is a multicentre prospective Canadian cohort study of persons with NMOSD and MOGAD. Standardized forms are utilized to collect information on patients through the disease course, including information on pregnancy. Females of reproductive age (15-50 years) were included in this analysis. We retrospectively evaluated pregnancies in NMOSD/MOGAD for pregnancy outcomes and disease activity. 

Results:

Among 99 individuals of reproductive age, there were 26 pregnancies in 23 participants (14 AQP4+, 4 AQP-/MOG-, 8 MOGAD pregnancies). Pregnant and non-pregnant groups had similar age of symptom onset and EDSS at enrolment. Immunotherapy with prednisone and/or azathioprine was used during pregnancy in 4/14 AQP4+ and 1/8 MOGAD pregnancies. Live birth occurred in 11 (79%) AQP4+, 2 (50%) AQP4-/MOG-, and 8 (100%) MOGAD pregnancies. Miscarriages/stillbirth occurred in 2 (14%) AQP4+ and 2 (50%) AQP4-/MOG- pregnancies. One AQP4+ participant had a pregnancy termination. There were no preterm births, congenital malformations, or pre-eclampsia/eclampsia. There was one relapse during pregnancy, in the second trimester in a seronegative participant who was not on immunotherapy. The proportion with postpartum relapse was high, affecting 10 (71%) AQP4+, 1 (25%) seronegative, and 7 (88%) MOGAD pregnancies. Most relapses occurred in the first 3 months postpartum. 

Conclusions:

In this multicentre study of women with NMOSD and MOGAD, pregnancy outcomes were generally favourable, and most pregnancies resulted in live birth. Unlike prior studies, most did not have relapses during pregnancy. Conversely, the rate of postpartum relapse was high in both NMOSD and MOGAD, with most attacks occurring within the first 3 months postpartum. Factors influencing pregnancy and disease outcomes warrant further investigation. 

10.1212/WNL.0000000000202285