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Pregnancy and neuromyelitis optica

Background: Neuromyelitis Optica (NMO) is a rare but severe disease affecting young adults with a mean age at onset of 34.5 years. The female: male ratio is 3:1 so most of patients are women of childbearing potential. They will ask clinician for risk of pregnancy but very few data are available. No study had looked for the influence of pregnancy on the course of NMO. Objective: The aim of this study was to precise the clinical course of NMO during and after pregnancy. We also looked the role of breast feeding and epidural analgesia on the rate of relapse. Methods: We performed an observational, multicenter study. Data were collected from Lille and Strasbourg University Hospitals. We calculated the annualized relapse rate (ARR) for the year before pregnancy (Y-1), during each trimester (the first: T1, the second: T2, the third: T3) of pregnancy and for the first (PP1) and the second (PP2) trimester post partum. Results: We identified 59 patients fulfilling the 2006 NMO criteria. There were 22 males and 36 females, among them 27 (75%) had children. Eleven patients (including 14 pregnancies) had their children during the course of NMO. We calculated the annualized relapse rate (ARR) for 6 main periods: before (0.5), during (0.64) and after (1.21) pregnancy. The ARR for each period was : 0.5 (Y-1); 0.29 (T1); 0.57 (T2 and T3), 1.14 (PP1); 0.85 (PP2). We did not find differences between patients with or without breastfeeding and epidural analgesia. Conclusion: These are the first data about influence of pregnancy on the NMO course. The results seem to be similar to those of the Pregnancy In Multiple Sclerosis (PRIMS) study with a rebound effect after delivery. These data have to be confirmed in larger studies.

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