Management of the pregnancy and delivery of a patient who have immune mediated nervous system disorder

Abstract

Immune mediated nervous system disorders are female–predominate diseases that often first presents during a women's childbearing years. We cannot treat their diseases without thinking their pregnancy and delivery. We focus on the pregnancy and delivery of a patient who have immune mediated nervous system disorders especially multiple sclerosis (MS), Neuromyelitis optica spectrum disorder (NMOSD) and myasthenia gravis (MG). Immunity of the pregnancy is performed on human maternal–fetal interface from early pregnancy. There are many decidual immune cells at maternal portion of placenta and they are the basis of maternal–fetal tolerance. The main components of them are NK cells, T cells, macrophages, dendritic cells. Decidual CD4＋T cells are shifted Th2 and Treg cells from Th1 and Th17 cells as it becomes in late pregnancy, so that most of the MS patients don't have a relapse. But after delivery, immune system changes and relapse rate returns to a state before the pregnancy. On the other hand, anti AQP4 anti body production increases during pregnancy. AQP4 was found on fetal villous surfaces in placenta. When NMO patients are not treated with immunosuppressive drugs, anti AQP4 antibodies bind AQP4 molecules and they cause placental inflammation and fetal death. Pregnancy outcomes of MG patients are quite better when their conditions are stable. NMO and MG patients should be treated during pregnancy. Most of the drugs are safe. Breast feeding should be considered by the factor which influences a mother's milk shift to a baby.