Objective:

To investigate for transplacental transmission of myelin oligodendrocyte glycoprotein (MOG)-IgG from mother to neonate and quantitate duration of maternal MOG-IgG through testing of serial samples in an infant.

Background:

 MOG antibody-associated disease (MOGAD) is a CNS-inflammatory demyelinating disease with a median age of onset of 20-30 years. Thus, women of childbearing age are commonly affected, and the postpartum period can be a time of increased risk of relapse. To our knowledge, no cases of neonatal MOGAD have been reported to date. 

Design/Methods:

We studied transmission of MOG-IgG from mother to neonate in a patient with MOGAD with a history of seropositivity for MOG-IgG. Using an in-house MOG-transfected cell-based flow cytometry assay, we measured titer of the antibody in serum of the mother, cord blood and newborn at time of birth. We tested monthly serial samples to quantitate duration of maternal MOG-IgG in the baby.

Results:

The patient first developed MOGAD in 2005 at the age of 16, when she had an episode of acute disseminated encephalomyelitis. She subsequently had a relapse of myelitis and optic neuritis for which she received plasma exchange. She delivered at age 32.  She had not been on any treatments in the 6 weeks prior to delivery. One month prior to delivery, the mother was positive for MOG-IgG (titer 1:20). At delivery, the mother was MOG-IgG negative, baby and cord blood were positive for MOG-IgG (titer 1:20). The baby was followed up for eight months and did not have any clinical features of MOGAD. Both mother and baby were negative for MOG-IgG at one month and two months post-delivery.

Conclusions:

Maternal MOG-IgG can be passively transferred to the fetus through the placenta and positivity in the baby occurred despite being below the threshold for detection in the mother. MOG-IgG in the baby was transient and without clinical manifestations.