Pregnancy-related relapse risk factors in women with anti-AQP4 antibody positivity and neuromyelitis optica spectrum disorder

Mult Scler. 2016 Oct;22(11):1413-1420. doi: 10.1177/1352458515583376. Epub 2015 Apr 28.


Background: Few reports describe the influence pregnancy has on the annualized relapse rate (ARR) in neuromyelitis optica spectrum disorder (NMOSD).

Objective: To examine pregnancy-related attacks (attacks during pregnancy or within 1 year postpartum) and identify the risk factors for an attack in Japanese NMOSD patients.

Methods: We retrospectively reviewed 139 Japanese women whom had aquaporin-4 (AQP4) antibody-positive NMOSD. Among the 114 patients with information, 47 women had 56 pregnancies. We compared the ARR before, during and after pregnancy.

Results: Of the 47 NMOSD patients with pregnancy, 22 women (46.8%) had a pregnancy-related attack of the disease (either an onset event or a relapse). The ARR was significantly higher in the first 3 months postpartum (1.80 ± 2.04), than before the pregnancy (0.57 ± 1.16; p = 0.0043) and did not significantly decrease during pregnancy. The ARR before hospitalization and treatment was analyzable in 55 patients without pregnancy and was 1.09 ± 1.17. Among the 11 patients with onset before pregnancy, nine patients had a pregnancy-related attack with a relapse in the previous year, and their immunosuppression was discontinued or made to be at low doses; while the two patients on higher-dose therapies were relapse-free.

Conclusion: In the present study, pregnancy-related attack was common in NMOSD, and unlike in multiple sclerosis, the ARR was not reduced during pregnancy. Discontinued or insufficient immunosuppression appeared to increase the risk of pregnancy-related attack.

Keywords: Anti-aquaporin-4 antibody; immunosuppression; immunosuppressive drugs; neonates; neuromyelitis optica; neuromyelitis optica spectrum disorders; pregnancy; recurrence; relapse rate; risk factors.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aquaporin 4 / immunology*
  • Autoantibodies / immunology*
  • Female
  • Humans
  • Japan
  • Neuromyelitis Optica / immunology*
  • Postpartum Period
  • Pregnancy
  • Pregnancy Complications / immunology*
  • Recurrence
  • Retrospective Studies
  • Young Adult


  • AQP4 protein, human
  • Aquaporin 4
  • Autoantibodies