@article{20a1d63d250245faaee1533ff92d0bf5,
title = "High risk of postpartum relapses in neuromyelitis optica spectrum disorder",
abstract = "Objective: To study the effect of pregnancy on the frequency of neuromyelitis optica spectrum disorder (NMOSD) relapse and evaluate rates of pregnancy-related complications in an international multicenter setting. Methods: We administered a standardized survey to 217 women with NMOSD from 7 medical centers and reviewed their medical records. We compared the annualized relapse rate (ARR) during a baseline period 2 years prior to a participant's first pregnancy to that during pregnancy and to the 9 months postpartum. We also assessed pregnancy-related complications. Results: There were 46 informative pregnancies following symptom onset in 31 women with NMOSD. Compared to baseline (0.17), ARR was increased both during pregnancy (0.44; p = 0.035) and during the postpartum period (0.69; p = 0.009). The highest ARR occurred during the first 3 months postpartum (ARR 1.33). A total of 8 of 76 (10.5%) with onset of NMOSD prior to age 40 experienced their initial symptom during the 3 months postpartum, 2.9 times higher than expected. Conclusions: The postpartum period is a particularly high-risk time for initial presentation of NMOSD. In contrast to published observations in multiple sclerosis, in neuromyelitis optica, relapse rate during pregnancy was also increased, although to a lesser extent than after delivery.",
author = "Klawiter, {Eric C.} and Riley Bove and Liene Elsone and Enrique Alvarez and Nadja Borisow and Melissa Cortez and Farrah Mateen and Mealy, {Maureen A.} and Jaime Sorum and Kerry Mutch and Tobyne, {Sean M.} and Klemens Ruprecht and Guy Buckle and Michael Levy and Dean Wingerchuk and Friedemann Paul and Cross, {Anne H.} and Anu Jacobs and Tanuja Chitnis and Brian Weinshenker",
note = "Funding Information: Study funding included the Guthy Jackson Charitable Foundation (Eureka Grant; E.C.K.). F.P. and K.R. were supported by the German Ministry for Education and Research (Competence Network Multiple Sclerosis). A.H.C. was supported the Manny & Rosalyn Rosenthal– Dr. John L. Trotter MS Center Chair. Funding Information: E. Klawiter has received consulting fees from Acorda Therapeutics, Atlas5d, Biogen Idec, EMD Serono, Genentech, and Shire and research support from Atlas5d, Biogen Idec, EMD Serono, and Roche. R. Bove and L. Elsone report no disclosures relevant to the manuscript. E. Alvarez has received consulting fees from Novartis, Biogen Idec, Teva Neuroscience, and Genzyme and support for research activities from Novartis, Biogen Idec, Acorda, and the Rocky Mountain Multiple Sclerosis Center. N. Borisow, M. Cortez, and F. Mateen report no disclosures relevant to the manuscript. M. Mealy has received honoraria from the Consortium of Multiple Sclerosis Centers. J. Sorum, K. Mutch, and S. Tobyne report no disclosures relevant to the manuscript. K. Ruprecht has received research support from Bundesministerium f{\"u}r Bildung und Forschung (Competence Network Multiple Sclerosis) and Novartis and honoraria from Bayer Healthcare, Biogen Idec, Merck Serono, Sanofi/Genzyme, Teva Neuroscience, Roche, and Novartis. G. Buckle has received personal compensation from Bayer, Biogen Idec, EMD-Serono, Genentech, Genzyme Corporation, Mallinckrodt, Novartis, and Teva Neuroscience as a consultant or speaker. Dr. Buckle has received research support from Biogen Idec. M. Levy has received research funding from Alexion, Gen-zyme, Acorda, Sanofi, TG Therapeutics, TerumoBCT, and Alnylam; consulted for Chugai/Roche, Sanofi, Alexion, and Acorda; and serves on the Scientific Advisory Board for Alexion and Acorda. D. Wingerchuk serves on the adjudication panel for MedImmune; is a consultant to Alexion, MedImmune, and Chugai Pharmaceuticals; is co-editor-in-chief for The Neurologist; and Alexion, TerumoBCT, and the Guthy Jackson Charitable Foundation. F. Paul has received honoraria and/or research support from Alexion, Bayer, Biogen, Chugai, MerckSerono, Novartis, Genyzme, MedImmune, Shire, and Teva Neuroscience; and has received funding from Deutsche Forschungsgemeinschaft (DFG Exc 257), Bundesministerium f{\"u}r Bildung und Forschung (Competence Network Multiple Sclerosis), Guthy Jackson Charitable Foundation, EU Framework Program 7, and National Multiple Sclerosis Society of the USA. A. Cross has received consulting fees from AbbVie, Biogen, EMD-Serono, Genentech, Genzyme/Sanofi, Roche, Teva Neuroscience, and Novartis. A. Jacob has received consulting and speaking fees and clinical trial grants from Biogen Idec, Alexion, Shire, and Chugai. T. Chitnis has received personal compensation for advisory board/consulting for Novar-tis and Biogen Idec and received financial support for research activities from Merck-Serono and Novartis Pharmaceuticals. B. Weinshenker has received consulting fees for participation on data safety monitoring boards for Novartis, Biogen Idec, and Mitsubishi Pharmaceuticals; consulting fees from MedImmune Pharmaceuticals for participation on an attack adjudication committee; and has received royalties from RSR Ltd. and Oxford University as a named coinventor of technology described in a patent held by Mayo Foundation for NMO-IgG for diagnosis of neuromyelitis optica. Go to Neurology.org for full disclosures. Publisher Copyright: {\textcopyright} 2017 American Academy of Neurology.",
year = "2017",
doi = "10.1212/WNL.0000000000004681",
language = "English (US)",
volume = "89",
pages = "2238--2244",
journal = "Neurology",
issn = "0028-3878",
publisher = "Lippincott Williams and Wilkins",
number = "22",
}