2019 Volume 89 Issue 6 Pages 115-126
In recent years, the number of patients with neuro-immunological diseases, such as multiple sclerosis (MS), neuromyelitis optica (NMO)/neuromyelitis optica spectrum disorder (NMOSD), and myasthenia gravis (MG), has been increasing in Japan. These diseases are commonly seen in women of childbearing age. Therefore, pregnancy and delivery are major issues in patients with these diseases. Pre-conception care and management of medication during pregnancy, resumption after delivery, breastfeeding, and effects on the mother and fetus are all very important issues.
In pregnancy in MS, the current guidelines focus on the use of disease-modifying drugs (DMDs) throughout pregnancy. The appropriate DMD prevents relapses for three months postpartum.
The annual recurrence rate after delivery was much higher for NMO・NMOSD than for MS. In addition, pregnancy after NMOSD onset is a risk factor for miscarriage, and pregnancies with high disease activity may be at increased risk of miscarriage.
Exacerbations of MG occur in approximately 41% of pregnancies, with remission in 29% and no change in 30%. Exacerbations occur in the first trimester and the three months postpartum. What is common in these autoimmune neurological diseases is that continuing appropriate treatment and stabilizing disease activity can prevent postpartum recurrence.
