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Neuromyelitis-optica-Spektrum-Erkrankung und Schwangerschaft

Neuromyelitis optica spectrum disorder and pregnancy

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Zusammenfassung

Hintergrund

Neuromyelitis-optica-Spektrum-Erkrankungen (NMOSD) sind autoimmun-entzündliche Erkrankungen des Zentralnervensystems (ZNS), die vorrangig Frauen betreffen. Ein Teil dieser Patientinnen erkrankt im gebärfähigen Alter, sodass Beratungsbedarf bezüglich Familienplanung und Schwangerschaften bestehen kann.

Ziel

Die aktuelle Publikation liefert einen Überblick zu den Themen Fertilität, Schwangerschaftskomplikationen und den Einfluss einer Schwangerschaft auf den NMOSD-Krankheitsverlauf. Darüber hinaus werden Therapieoptionen während der Schwangerschaft dargestellt.

Material und Methoden

Mithilfe der Datenbank PubMed erfolgte eine Recherche der aktuellen Literatur.

Ergebnisse und Diskussion

Tierexperimentelle Studien weisen auf Einschränkungen der Fertilität bei NMOSD hin, zur Fertilität von NMOSD-Patientinnen existieren bislang jedoch keine ausreichenden Daten. Eine Schwangerschaft bei NMOSD-Patientinnen geht mit einer erhöhten postpartalen Krankheitsaktivität sowie einem höheren Grad der Behinderung nach einer Schwangerschaft einher. Es liegen Hinweise auf ein erhöhtes Risiko für Schwangerschaftskomplikationen wie Spontanaborte und eine Präeklampsie vor. Zur Therapie eines akuten Schubs während einer Schwangerschaft können Methylprednisolon und/oder Plasmapherese/Immunadsorption eingesetzt werden. Das Absetzen bzw. die Fortführung einer immunsuppressiven Therapie mit Azathioprin oder Rituximab sollte kritisch unter Berücksichtigung der bisherigen Krankheitsaktivität abgewogen werden. Daher ist eine Mitbetreuung von NMOSD-Patienten, insbesondere in besonderen Situationen wie einer Schwangerschaft, durch spezialisierte Zentren empfehlenswert.

Abstract

Background

Neuromyelitis optica spectrum disorders (NMOSD) are autoimmune inflammatory diseases of the central nervous system that mainly affect women. In some of these patients NMOSD occurs during fertile age. For this reason, treating physicians may be confronted with questions concerning family planning, pregnancy and birth.

Objective

This study provides an overview on the influence of NMOSD on fertility, pregnancy complications and pregnancy outcome. The effect of pregnancy on NMOSD course and therapy options during pregnancy are discussed.

Material and methods

A search of the current literature was carried out using the PubMed database.

Results and conclusion

Animal studies have shown lower fertility rates in NMOSD; however, studies investigating fertility in NMOSD patients are lacking. Pregnancy in NMOSD patients are associated with an increase in postpartum disease activity and a higher grade of disability after pregnancy. Some studies showed higher risks of pregnancy complications e. g. spontaneous abortions and preeclampsia. With a few limitations, acute relapses during pregnancy can be treated with methylprednisolone and/or plasma exchange/immunoadsorption. Stopping or continuing immunosuppressive therapy with azathioprine or rituximab during pregnancy should be critically weighed considering previous and current disease activity. Therefore, a joint supervision by a specialized center is recommended, particularly in specific situations such as pregnancy.

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Authors and Affiliations

  1. NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Deutschland

    N. Borisow & F. Paul

  2. Klinik für Neurologie, St. Josef Hospital, Ruhr Universität Bochum, Bochum, Deutschland

    K. Hellwig

  3. Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité – Universitätsmedizin Berlin, Berlin, Deutschland

    F. Paul

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Correspondence to N. Borisow.

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F. Paul gehört dem wissenschaftlichen Beirat von Novartis an, erhielt Vortragshonorare und Reisekostenerstattungen von Bayer, Novartis, Biogen Idec, Teva, Sanofi-Aventis/Genzyme, Merck Serono, Alexion, Chugai, MedImmune und Shire, ist Academic Editor von PLoS One, ist Associate Editor von Neurology® Neuroimmunology & Neuroinflammation; übte Beratertätigkeiten für Sanofi-Genzyme, Biogen Idec, MedImmune, Shire und Alexion aus; erhielt Forschungsunterstützung von Bayer, Novartis, Biogen Idec, Teva, Sanofi-Aventis/Genzyme, Alexion, Merck Serono, von der Deutschen Forschungsgemeinschaft, Werth Stiftung der Stadt Köln, Bundesministerium für Bildung und Forschung, Arthur Arnstein Stiftung Berlin, EU FP7 Rahmenprogramm, Guthy Jackson Charitable Foundation und National Multiple Sclerosis of the USA. K. Hellwig weist auf folgende Beziehungen hin: Beratertätigkeiten und Vortragshonorare, sowie Forschungsunterstützung von Bayer Healthcare, Biogen, Novartis Pharma, Teva Pharma, Roche, Sanofi-Genzyme und Merck. N. Borisow gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Borisow, N., Hellwig, K. & Paul, F. Neuromyelitis-optica-Spektrum-Erkrankung und Schwangerschaft. Nervenarzt 89, 666–673 (2018). https://doi.org/10.1007/s00115-018-0486-4

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