Pregnancy Outcomes in Patients with Neuromyelitis Optica: A Systematic Review [33E

Abstract

INTRODUCTION: Neuromyelitis Optica (NMO) is an antibody-mediated disorder characterized by recurrent myelitis and optic neuritis. Our objective was to systematically review pregnancy outcomes in women with NMO to aid counselling and management. METHODS: We searched MEDLINE, EMBASE, Web of Science, and PubMed from 1946 until August 2016 for relevant articles. Article selection, data extraction and quality assessment (QA), using the Joanna Briggs QA tool, were performed in duplicate. Outcomes were reported as proportions. RESULTS: We identified 2096 studies and included 22 studies describing 146 pregnancies in 112 women with NMO. QA scores for case reports and series were 7/8 and 5/10 respectively. The mean maternal age was 30±4 years and diagnosis-to-pregnancy interval was 6±4 years. De novo symptoms developed in 37%. Maternal outcomes included one postpartum death, one haemorrhagic stroke, one case of respiratory paralysis and 27 relapses, most of which involved myelitis (16) and optic neuritis (6). Relapses were treated with high-dose corticosteroids (20), plasmapheresis (15), immunosuppressants (11) and intravenous immunoglobulin (6), resulting in complete (12) or partial (10) recovery in most. In two cases symptoms worsened despite treatment, requiring emergency caesarean delivery. There were 121 (83%) livebirths, 115 (95%) of which were >37 weeks, 18 pregnancy terminations, five miscarriages, two stillbirths and no adverse outcomes on postnatal follow up (average 9 months). CONCLUSION: NMO is often diagnosed in pregnancy. Although women with NMO are at risk for relapses requiring aggressive management with high-dose corticosteroids, plasma exchange and immunosuppressants, retrospective data suggest that maternal and perinatal outcomes are comparable to the general population.