Outcome of pregnancies after onset of the neuromyelitis optica spectrum disorder
Outcome of pregnancies after onset of the neuromyelitis optica spectrum disorder
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DOI：
10.1111/ene.14274
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发表时间：
2020-05-25
影响因子：
5.1
通讯作者：
Kim, H. J.
中科院分区：
文献类型：
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作者：
Kim, S. -H.;Huh, S. -Y.;Kim, H. J.
背景和目的关于视神经脊髓炎谱系障碍(NMOSD)妊娠结局的数据仍然有限，特别是对于怀孕前接受过免疫抑制治疗的妇女。本研究的目的是评估NMOSD发病后试图怀孕的NMOSD患者的妊娠结局，并确定预测妊娠相关攻击的危险因素。方法对29例NMOSD发病后试图怀孕的患者的病历进行回顾评估，并对患者的妊娠结局进行访谈。妊娠相关发作被定义为发生在怀孕期间或分娩后1年内的发作。结果29例患者中，26例在NMOSD症状出现后怀孕33次。NMOSD发病后的33次妊娠导致24例活产(除1例低出生体重外的健康新生儿)、6例流产和3例选择性流产。在开始免疫抑制治疗之前，12例妊娠中有9例(75%)发生了与妊娠相关的疾病，而在开始免疫抑制治疗后，21例中只有5例(24%)发生了与妊娠相关的发作(P=0.009)。多变量分析显示，利妥昔单抗治疗后妊娠相关发作与妊娠呈负相关(优势比0.048，95%可信区间0.004~0.546)。结论无母婴并发症的妊娠是可行的。孕前接受利妥昔单抗治疗可能有助于预防NMOSD患者与妊娠相关的发作。
Background and purpose Data on the pregnancy outcome of neuromyelitis optica spectrum disorder (NMOSD) remain limited, especially for woman who had received immunosuppressive treatment before becoming pregnant. The aim was to evaluate the outcome of pregnancy amongst patients with NMOSD who attempted to become pregnant after NMOSD onset and to identify risk factors that predict pregnancy-related attack.Methods Medical records from 29 patients who attempted to become pregnant after NMOSD onset were retrospectively evaluated and the patients were interviewed for pregnancy outcomes. Pregnancy-related attack was defined as an attack that occurred during pregnancy or within 1 year of delivery.Results Amongst the 29 patients, 26 had 33 pregnancies after NMOSD symptom onset. The 33 pregnancies after NMOSD onset resulted in 24 live births (healthy neonates except one with low birth weight), six miscarriages and three elective abortions. Pregnancy-related attack occurred in nine (75%) of 12 pregnancies before initiation of immunosuppressive therapy, but in only five (24%) of 21 pregnancies after initiation of immunosuppressive therapy (P = 0.009). Multivariable analysis indicated that pregnancy-related attack was negatively associated with pregnancy after initiation of rituximab (odds ratio 0.048, 95% confidence interval 0.004-0.546).Conclusion Successful pregnancy without maternal and neonatal complications may be feasible in patients with NMOSD. Rituximab treatment before pregnancy might help to prevent pregnancy-related attack in patients with NMOSD.