Study Fertility Characteristics in Female Patients with Neuromyelitis Optica Spectrum Disorder

Abstract

Neuromyelitis optica spectrum disorder (NMOSD) predominantly affect women who are of childbearing age. Understanding the interactions between pregnancy and NMOSD is important for clinical management. To study the fertility characteristics in patients with NMOSD in Cairo university hospital MS Multiple Sclerosis (MS) clinic and determine the interrelation between NMOSD, menstruation, pregnancy outcome. It is an observational cross-sectional study conducted on 83 female patients (67 married and 16 unmarried) diagnosed with NMOSD according to an international consensus (2006, 2015) and 30 unmarried healthy female as control group. All patients were subject to full demographic and clinical history from their medical records and personal interview, full neurological examination, expanded disability status scale (EDSS), and pregnancy registry questionnaire. There was significant increase in percentage of amenorrhea and decrease in menstrual flow days in unmarried patients compared to control (p-value =0.05, 0.04 respectively with OR=3.5), compared to married patients before and after disease onset. Regarding to pregnancy characteristics, there was significant increase in the number of abortions, percentage of cesarean section, decrease in the number of living fetuses, normal fetuses, breast feeding percentage after disease onset compared to pregnancies occurred before disease onset (p value= 0.02, <0.001, 0.001, 0.02, <0.001 with OR= 2.7, 5.2, 4.9 respectively). There was significant increase in the number of postpartum relapse (66% from pregnancies after disease onset), most of them in first 3 months postpartum (88.7%). Presence of NMOSD increased the percentage of amenorrhea/oligomenorrhea, miscarriage, delivery by Cesarean section, and decreased the chance for breastfeeding. Moreover, pregnancy increases NMOSD relapse and subsequently disability.