This video explores the unique considerations for women diagnosed with neuromyelitis optica spectrum disorder (NMOSD) planning a pregnancy, featuring expert insights from Dr. Celia Oreja-Guevara. It discusses the safety of pregnancy, risks during the postpartum period, the importance of tailored treatments, and the evolving landscape of NMOSD care, offering hope for better outcomes through advanced diagnostics and personalized therapies.

Navigating NMOSD and Pregnancy with Dr. Celia Oreja-Guevara

[Dr Celia Oreja-Guevara, Vice Chair of Neurology Hospital Clinico San Carlos Madrid, Spain. ]

00:07 Is it safe for women with NMOSD to become pregnant and what are the risks during pregnancy?

So NMO is a different disease from multiple sclerosis so there are different considerations. Pregnancy is not contraindicated in NMO, but there are some risks that we don't have in multiple sclerosis. We have an antibody that is the aquaporin-4 antibody, and we know that because of the aquaporin-4 antibody we have a higher risk of spontaneous abortion and a higher risk of premature deliveries. So we need to take this into account when our patients become pregnant. But the newborns will not have more malignancies, and there will be not a problem during the pregnancy or during the delivery.

00:54 What precautions should women with NMOSD take when planning a pregnancy?

When a patient would like to be to become pregnant, it's very important that we have a planned pregnancy. It means they should be one year stable, completely stable without any relapses, any new lesions in the MRI. When they have treatment, we need to look to see which treatment it is because some of the treatments are teratogenic and they cannot become pregnant with teratogenic treatment so they need to have contraception before and in the case that they want to become pregnant they should stop the treatment. Another consideration is if they want to have breastfeeding or no breastfeeding after the delivery and if they have higher aquaporin positive titers. Why? Because there is it should be a relation between aquaporin positive titers and more relapses in the third trimester. So that we need to take careful to be careful in the third trimester for the case that the patients have a relapse. And we should look at the aquaporin-4 titers before the pregnancy because when they are really very high, we have more risk to have relapses in the third trimester or after the delivery.

02:09 Does NMOSD impact labour, delivery and recovery after childbirth?

NMO has no impact in the delivery. The patients they can deliver in a natural way or they can have a C-section, there is not a problem. There is not a problem with the anesthesia. They can receive an epidural anesthesia, complete anesthesia, that is not a problem. And after the delivery, there is always a risk of relapses so at that moment the physician and the patient should think about to start with the treatment directly after the delivery or to wait and to have breastfeeding.

02:45 Are there any risks of NMOSD-related complications for the newborn?

The newborns of mothers with NMO, they have no complications, they have no problems. It could be that in some cases the aquaporin-4 antibodies are coming through the placenta, and the baby is with these antibodies, but these antibodies are not producing NMO. So that there are really no risks for the newborns.

03:12 Can NMOSD be passed genetically to offspring and should genetic counselling be considered?

NMO is not a genetic disease, it means there are no problems so the children will not have an inheritance of the parents so there is no risk. And because there is no risk, we don't need a genetic assessment.



03:33 What does the future look like for NMOSD patients?

I think the future looks very, very good. I think there will be great news. We will have new treatments, 3 or 4 new treatments. They will be better for the patients, more personalised treatments. And the most important thing there will be the biomarkers. We will have biomarkers which predict the relapses so that when we know that when the relapse will come, we can treat the patients before or we can change the treatment before the relapse so that at the end we will use all these biomarkers to avoid relapses. So that in the future, the patients, they will have less relapses because of the treatments and less relapses because we can predict, and we can change our treatment.

As Dr. Oreja-Guevara mentioned, early planning and tailored care are key to ensuring the best outcomes for both mother and baby. Speak to your doctor if you have any concerns.

For more information on NMOSD and patient resources, visit: www.nmosd-in-focus.com.