Neuroimmunological Disorders: The Gender Effect

Neurol Clin. 2023 May;41(2):315-330. doi: 10.1016/j.ncl.2022.10.004. Epub 2023 Feb 14.


Multiple sclerosis is a disease that tends to affect women during their childbearing years. Although relapse risk decreases during pregnancy, patients should still be optimized on disease-modifying therapy before and after pregnancy to minimize gaps in treatment. Exclusive breastfeeding may reduce the chances of disease relapse postpartum, and many disease-modifying therapies are considered to be safe while breastfeeding. Treatments for other neuroimmunologic disorders such as neuromyelitis optica spectrum disorder, myelin oligodendrocyte glycoprotein antibody-associated disease, neurosarcoidosis, and central nervous system vasculitis may require rituximab before and prednisone or intravenous immunoglobulin therapy during pregnancy.

Keywords: Breastfeeding; Disease-modifying therapy; Fertility; Multiple sclerosis; Pregnancy.

Publication types

  • Review

MeSH terms

  • Autoantibodies
  • Female
  • Humans
  • Multiple Sclerosis* / diagnosis
  • Multiple Sclerosis* / drug therapy
  • Neuromyelitis Optica* / complications
  • Pregnancy
  • Recurrence
  • Rituximab


  • Autoantibodies
  • Rituximab