EPMA Journal

, Volume 9, Issue 3, pp 249–256 | Cite as

Neuromyelitis optica spectrum disorders and pregnancy: relapse-preventive measures and personalized treatment strategies

  • Nadja BorisowEmail author
  • Kerstin Hellwig
  • Friedemann Paul


Neuromyelitis optica spectrum disorders (NMOSD) are autoimmune inflammatory diseases of the central nervous system that predominately affect women. Some of these patients are of childbearing age at NMOSD onset. This study reviews, on the one hand, the role NMOSD play in fertility, pregnancy complications and pregnancy outcome, and on the other, the effect of pregnancy on NMOSD disease course and treatment options available during pregnancy. Animal studies show lower fertility rates in NMOSD; however, investigations into fertility in NMOSD patients are lacking. Pregnancies in NMOSD patients are associated with increased disease activity and more severe disability postpartum. Some studies found higher risks of pregnancy complications, e.g., miscarriages and preeclampsia. Acute relapses during pregnancy can be treated with methylprednisolone and/or plasma exchange/immunoadsorption. A decision to either stop or continue immunosuppressive therapy with azathioprine or rituximab during pregnancy should be evaluated carefully and factor in the patient’s history of disease activity. To this end, involving neuroimmunological specialist centers in the treatment and care of pregnant NMOSD patients is recommended, particularly in specific situations like pregnancy.


Neuromyelitis optica Devic’s syndrome Pregnancy Relapse prevention Personalized treatment 


Compliance with ethical standards

Ethical approval

For this type of study, formal consent is not required.

Conflict of interest

N. Borisow declares no conflict of interest.

F. Paul is a member of the scientific advisory board of Novartis; has received lecture fees and travel reimbursement from Bayer, Novartis, Biogen Idec, Teva, Sanofi-Aventis/Genzyme, Merck Serono, Alexion, Chugai, MedImmune, and Shire; is academic editor of PLoS One, Associate Editor of Neurology® Neuroimmunology & Neuroinflammation; consulted for Sanofi-Genzyme, Biogen Idec, MedImmune, Shire, and Alexion; and received research support from Bayer, Novartis, Biogen Idec, Teva, Sanofi-Aventis/Genzyme, Alexion, Merck Serono, the German Research Foundation, the Werth Foundation of the city of Cologne, the German Federal Ministry of Research and Education, the Arthur Arnstein Stiftung Berlin, the EU FP7 Framework Program, Jackson Charitable Foundation, and the National Multiple Sclerosis of the USA.

K. Hellwig received consultant and lecture fees and research support from Bayer Healthcare, Biogen, Novartis Pharma, Teva Pharma, Roche, and Sanofi-Genzyme und Merck.

The NEMOS cohort/NationNMO is supported by the German Ministry for Education and Research (BMBF) as part of the German Competence Network Multiple Sclerosis (KKNMS; for NEMOS NationNMO-LAB FKZ 01GI1602A to B.W., NationNMO-PAT FKZ 01GI1602B to O.A., and NationNMO-DAB FKZ 01GI1602C to J.S.).

Human and animal studies

This paper included no studies of humans or animals.


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Copyright information

© European Association for Predictive, Preventive and Personalised Medicine (EPMA) 2018

Authors and Affiliations

  • Nadja Borisow
    • 1
    Email author
  • Kerstin Hellwig
    • 2
  • Friedemann Paul
    • 1
    • 3
  1. 1.NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of HealthBerlinGermany
  2. 2.Clinic for Neurology, St. Josef HospitalRuhr Universität BochumBochumGermany
  3. 3.Experimental and Clinical Research CenterMax Delbrueck Center for Molecular Medicine and Charité – Universitätsmedizin BerlinBerlinGermany

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