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Demyelinating Disease and Pregnancy

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Neurology and Psychiatry of Women

Abstract

Multiple Sclerosis (MS) and Neuromyelitis Optica (NMO) are chronic inflammatory disorders of the central nervous system that often affect women during their childbearing years. Therefore, many patients and providers navigate pregnancy-related management decisions. The current review provides updated information on the clinical effects of pregnancy on MS and NMO course, as well as the available data on safety of immunomodulatory MS treatments for pregnant and lactating women. We also address broader management issues of women with MS and NMO during conception, gestation and the postpartum period.

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References

  1. Bove R, Chitnis T. The role of gender and sex hormones in determining the onset and outcome of multiple sclerosis. Mult Scler J. 2014;20(5):520–6.

    Article  CAS  Google Scholar 

  2. Hellwig K, Correale J. Artificial reproductive techniques in multiple sclerosis. Clin Immunol. 2013;149(2):219–24.

    Article  CAS  PubMed  Google Scholar 

  3. Visser JA, Schipper I, Laven JS, Themmen AP. Anti-Müllerian hormone: an ovarian reserve marker in primary ovarian insufficiency. Nat Rev Endocrinol. 2012;8(6):331–41.

    Article  CAS  PubMed  Google Scholar 

  4. Thöne J, Kollar S, Nousome D, et al. Serum anti-Müllerian hormone levels in reproductive-age women with relapsing–remitting multiple sclerosis. Mult Scler J. 2015;21(1):41–7.

    Article  CAS  Google Scholar 

  5. Grinsted L, Heltberg A, Hagen C, Djursing H. Serum sex hormone and gonadotropin concentrations in premenopausal women with multiple sclerosis. J Intern Med. 1989;226(4):241–4.

    Article  CAS  PubMed  Google Scholar 

  6. Bove R, Alwan S, Friedman JM, et al. Management of multiple sclerosis during pregnancy and the reproductive years: a systematic review. Obstet Gynecol. 2014;124(6):1157–68.

    Article  CAS  PubMed  Google Scholar 

  7. Cavalla P, Rovei V, Masera S, et al. Fertility in patients with multiple sclerosis: current knowledge and future perspectives. Neurol Sci. 2006;27(4):231–9.

    Article  CAS  PubMed  Google Scholar 

  8. Harward L, Mitchell K, Pieper C, Copland S, Criscione-Schreiber L, Clowse M. The impact of cyclophosphamide on menstruation and pregnancy in women with rheumatologic disease. Lupus. 2013;22(1):81–6.

    Article  CAS  PubMed  Google Scholar 

  9. Demirkiran M, Sarica Y, Uguz S, Yerdelen D, Aslan K. Multiple sclerosis patients with and without sexual dysfunction: are there any differences? Mult Scler J. 2006;12(2):209–11.

    Article  CAS  Google Scholar 

  10. Dahl J, Myhr K-M, Daltveit A, Hoff J, Gilhus N. Pregnancy, delivery, and birth outcome in women with multiple sclerosis. Neurology. 2005;65(12):1961–3.

    Article  CAS  PubMed  Google Scholar 

  11. van der Kop ML, Pearce MS, Dahlgren L, et al. Neonatal and delivery outcomes in women with multiple sclerosis. Ann Neurol. 2011;70(1):41–50.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Beecham AH, Patsopoulos NA, Xifara DK, et al. Analysis of immune-related loci identifies 48 new susceptibility variants for multiple sclerosis. Nat Genet. 2013;45(11):1353.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Didonna A, Oksenberg JR. Genetic determinants of risk and progression in multiple sclerosis. Clin Chim Acta. 2015;449:16–22.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Langagergaard V, Pedersen L, Gislum M, Nørgard B, Sørensen HT. Birth outcome in women treated with azathioprine or mercaptopurine during pregnancy: a Danish nationwide cohort study. Aliment Pharmacol Ther. 2007;25(1):73–81.

    Article  CAS  PubMed  Google Scholar 

  15. Ascherio A, Munger KL, Lünemann JD. The initiation and prevention of multiple sclerosis. Nat Rev Neurol. 2012;8(11):602–12.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Munger KL, Åivo J, Hongell K, Soilu-Hänninen M, Surcel H-M, Ascherio A. Vitamin D status during pregnancy and risk of multiple sclerosis in offspring of women in the Finnish maternity cohort. JAMA Neurol. 2016;73(5):515–9.

    Article  PubMed  PubMed Central  Google Scholar 

  17. ACOG Committee on Obstetric Practice. Vitamin D: screening and supplementation during pregnancy. Committee opinion no. 495. Obstet Gynecol 2011;118:197–198.

    Google Scholar 

  18. Confavreux C, Hutchinson M, Hours MM, Cortinovis-Tourniaire P, Moreau T, Group PiMS. Rate of pregnancy-related relapse in multiple sclerosis. N Engl J Med. 1998;339(5):285–91.

    Article  CAS  PubMed  Google Scholar 

  19. Vukusic S, Hutchinson M, Hours M, et al. Pregnancy and multiple sclerosis (the PRIMS study): clinical predictors of post-partum relapse. Brain. 2004;127(6):1353–60.

    Article  PubMed  Google Scholar 

  20. Salemi G, Callari G, Gammino M, et al. The relapse rate of multiple sclerosis changes during pregnancy: a cohort study. Acta Neurol Scand. 2004;110(1):23–6.

    Article  CAS  PubMed  Google Scholar 

  21. Hanulíková P, Vlk R, Meluzínová E, et al. Pregnancy and multiple sclerosis-outcomes analysis 2003–2011. Ceska Gynekol/Ceska Lekarska Spolecnost J Ev Purkyne. 2013;78(2):142–8.

    Google Scholar 

  22. Runmarker B, Andersen O. Pregnancy is associated with a lower risk of onset and a better prognosis in multiple sclerosis. Brain. 1995;118(1):253–61.

    Article  PubMed  Google Scholar 

  23. Stenager E, Stenager E, Jensen K. Effect of pregnancy on the prognosis for multiple sclerosis. A 5-year follow up investigation. Acta Neurol Scand. 1994;90(5):305–8.

    Article  CAS  PubMed  Google Scholar 

  24. Mueller BA, Zhang J, Critchlow CW. Birth outcomes and need for hospitalization after delivery among women with multiple sclerosis. Am J Obstet Gynecol. 2002;186(3):446–52.

    Article  PubMed  Google Scholar 

  25. Dwosh E, Guimond C, Sadovnick A. Reproductive counselling for MS: a rationale. Int MS J. 2003;10(2):52–9.

    CAS  PubMed  Google Scholar 

  26. Boivin J, Bunting L, Collins JA, Nygren KG. International estimates of infertility prevalence and treatment-seeking: potential need and demand for infertility medical care. Hum Reprod. 2007;22(6):1506–12.

    Article  PubMed  Google Scholar 

  27. Laplaud D-A, Leray E, Barriere P, Wiertlewski S, Moreau T. Increase in multiple sclerosis relapse rate following in vitro fertilization. Neurology. 2006;66(8):1280–1.

    Article  PubMed  Google Scholar 

  28. Michel L, Foucher Y, Vukusic S, et al. Increased risk of multiple sclerosis relapse after in vitro fertilisation. J Neurol Neurosurg Psychiatry. 2012;83(8):796–802.

    Article  PubMed  Google Scholar 

  29. Correale J, Farez MF, Ysrraelit MC. Increase in multiple sclerosis activity after assisted reproduction technology. Ann Neurol. 2012;72(5):682–94.

    Article  CAS  PubMed  Google Scholar 

  30. Hellwig K, Beste C, Brune N, et al. Increased MS relapse rate during assisted reproduction technique. J Neurol. 2008;255(4):592–3.

    Article  PubMed  Google Scholar 

  31. Hellwig K, Schimrigk S, Beste C, Müller T, Gold R. Increase in relapse rate during assisted reproduction technique in patients with multiple sclerosis. Eur Neurol. 2009;61(2):65–8.

    Article  PubMed  Google Scholar 

  32. Bove R, Rankin K, Lin C, Zhao C, Correale J, Michel L, Chitnis T. Assisted reproductive technologies and relapse risk: a new case series, and pooled analysis of existing studies. Poster presented at ECTRIMS 2017 Oct 25–28; Paris; 2017.

    Google Scholar 

  33. Coyle PK. Management of women with multiple sclerosis through pregnancy and after childbirth. Ther Adv Neurol Disord. 2016;9(3):198–210.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Wundes A, Pebdani RN, Amtmann D. What do healthcare providers advise women with multiple sclerosis regarding pregnancy? Mult Scler Int. 2014;819216.

    Google Scholar 

  35. Hatcher SE, Waubant E, Nourbakhsh B, Crabtree-Hartman E, Graves JS. Rebound syndrome in patients with multiple sclerosis after cessation of fingolimod treatment. JAMA Neurol. 2016;73(7):790–4.

    Article  PubMed  Google Scholar 

  36. Novi G, Ghezzi A, Pizzorno M, et al. Dramatic rebounds of MS during pregnancy following fingolimod withdrawal. Neurol-Neuroimmunol Neuroinflammation. 2017;4(5):e377.

    Article  Google Scholar 

  37. Sempere A, Berenguer-Ruiz L, Feliu-Rey E. Rebound of disease activity during pregnancy after withdrawal of fingolimod. Eur J Neurol. 2013;20(8):e109–10.

    Article  CAS  PubMed  Google Scholar 

  38. Thöne J, Thiel S, Gold R, Hellwig K. Treatment of multiple sclerosis during pregnancy–safety considerations. Expert Opin Drug Saf. 2017;16(5):523–34.

    Article  PubMed  Google Scholar 

  39. Coyle PK, Sinclair S, Scheuerle A, Thorp J, Albano J, Rametta M. Final results from the betaseron (interferon β-1b) pregnancy registry: a prospective observational study of birth defects and pregnancy-related adverse events. BMJ Open. 2014;4(5):e004536.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Thiel S, Langer-Gould A, Rockhoff M, et al. Interferon-beta exposure during first trimester is safe in women with multiple sclerosis—a prospective cohort study from the German multiple sclerosis and pregnancy registry. Mult Scler J. 2016;22(6):801–9.

    Article  CAS  Google Scholar 

  41. Amato M, Portaccio E, Ghezzi A, et al. Pregnancy and fetal outcomes after interferon-β exposure in multiple sclerosis. Neurology. 2010;75(20):1794–802.

    Article  CAS  PubMed  Google Scholar 

  42. Boskovic R, Wide R, Wolpin J, Bauer D, Koren G. The reproductive effects of beta interferon therapy in pregnancy a longitudinal cohort. Neurology. 2005;65(6):807–11.

    Article  CAS  PubMed  Google Scholar 

  43. Patti F, Cavallaro T, Fermo SL, et al. Is in utero early-exposure to interferon beta a risk factor for pregnancy outcomes in multiple sclerosis? J Neurol. 2008;255(8):1250–3.

    Article  CAS  PubMed  Google Scholar 

  44. Lu E, Wang BW, Guimond C, Synnes A, Sadovnick D, Tremlett H. Disease-modifying drugs for multiple sclerosis in pregnancy a systematic review. Neurology. 2012;79(11):1130–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Waubant E, Sadovnick AD. Interferon beta babies. Neurology. 2005;65(6):788–9.

    Article  PubMed  Google Scholar 

  46. Hale TW, Siddiqui AA, Baker TE. Transfer of interferon β-1a into human breastmilk. Breastfeed Med. 2012;7(2):123–5.

    Article  PubMed  Google Scholar 

  47. Voskuhl R, Momtazee C. Pregnancy: effect on multiple sclerosis, treatment considerations, and breastfeeding. Neurotherapeutics. 2017;14:1–11.

    Article  CAS  Google Scholar 

  48. Fragoso YD, Finkelsztejn A, Kaimen-Maciel DR, et al. Long-term use of glatiramer acetate by 11 pregnant women with multiple sclerosis. CNS Drugs. 2010;24(11):969–76.

    CAS  PubMed  Google Scholar 

  49. Herbstritt S, Langer-Gould A, Rockhoff M, et al. Glatiramer acetate during early pregnancy: a prospective cohort study. Mult Scler J. 2016;22(6):810–6.

    Article  CAS  Google Scholar 

  50. Neudorfer O, Melamed-Gal S, Baruch P. Pregnancy outcomes in patients with multiple sclerosis and exposure to branded glatiramer acetate during all three trimesters. Poster presented at ECTRIMS 2017 Oct 25–28; Paris; 2017.

    Google Scholar 

  51. Hellwig K. Pregnancy in multiple sclerosis. Eur Neurol. 2014;72(Suppl. 1):39–42.

    Article  PubMed  Google Scholar 

  52. Gold R, Phillips JT, Havrdova E, et al. Delayed-release dimethyl fumarate and pregnancy: preclinical studies and pregnancy outcomes from clinical trials and postmarketing experience. Neurol Ther. 2015;4(2):93–104.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Biogen Idec Inc. Tecfidera, Dimethy; Fumarte package insert. Massachusetts: Biogen Idec; 2014.

    Google Scholar 

  54. Almas S, Vance J, Baker T, Hale T. Management of multiple sclerosis in the breastfeeding mother. Mult Scler Int. 2016;2016:6527458.

    Google Scholar 

  55. Karlsson G, Francis G, Koren G, et al. Pregnancy outcomes in the clinical development program of fingolimod in multiple sclerosis. Neurology. 2014;82(8):674–80.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Houtchens MK, Sadovnick AD. Health issues in women with multiple sclerosis. Springer; 2017.

    Google Scholar 

  57. Collins W, Francis G, Koren G, et al. Lack of interaction between fingolimod (FTY720) and oral contraceptives, and pregnancy experience in the clinical program of fingolimod in multiple sclerosis. Paper presented at: Neurology. 2011.

    Google Scholar 

  58. Buraga I, Popovici R-E. Multiple sclerosis and pregnancy: current considerations. Sci World J. 2014;513160.

    Google Scholar 

  59. Vukusic S, Marignier R. Multiple sclerosis and pregnancy in the ‘treatment era’. Nat Rev Neurol. 2015;11(5):280–9.

    Article  PubMed  Google Scholar 

  60. Brent Robert L. Teratogen update—reproductive risks of leflunomide (Arava TM); a pyrimidine synthesis inhibitor: counseling women taking leflunomide before or during pregnancy and men taking leflunomide who are contemplanting fathering a child. Teratology. 2001;63:106–12.

    Article  Google Scholar 

  61. Cassina M, Johnson D, Robinson L, et al. Pregnancy outcome in women exposed to leflunomide before or during pregnancy. Arthritis Rheumatol. 2012;64(7):2085–94.

    Article  CAS  Google Scholar 

  62. AUBAGIO prescribing information. Cambridge: Genzyme Corporation, a Sanofi company; 2012. Available from: http://products.sanofi.us/aubagio/aubagio.pdf. Accessed 18 Jan 2018.

  63. Biogen Idec Inc. Daclizumab package insert. Massachusetts: Biogen Idec; 2016.

    Google Scholar 

  64. Gold R, Stefoski D, Selmaj K, et al. Pregnancy experience: nonclinical studies and pregnancy outcomes in the daclizumab clinical study program. Neurol Ther. 2016;5(2):169–82.

    Article  PubMed  PubMed Central  Google Scholar 

  65. EMA. Zinbryta® (daclizumab) – EPAR summary of product characteristics. Available from: http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Product_Information/human/003862/WC500210598.pdf.

  66. Haghikia A, Langer-Gould A, Rellensmann G, et al. Natalizumab use during the third trimester of pregnancy. JAMA Neurol. 2014;71(7):891–5.

    Article  PubMed  Google Scholar 

  67. Kümpfel T, Thiel S, Meinl I, Gold R, Hellwig K. Long-term exposure to natalizumab during pregnancy – a prospective case series from the German multiple sclerosis and pregnancy registry. Poster presented at ECTRIMS 2017 Oct 25-28; Paris; 2017.

    Google Scholar 

  68. Baker TE, Cooper SD, Kessler L, Hale TW. Transfer of natalizumab into breast milk in a mother with multiple sclerosis. J Hum Lact. 2015;31(2):233–6.

    Article  PubMed  Google Scholar 

  69. Gelfand JM, Cree BA, Hauser SL. Ocrelizumab and other CD20+ B-cell-depleting therapies in multiple sclerosis. Neurotherapeutics. 2017;14:1–7.

    Article  CAS  Google Scholar 

  70. Klink D, Van Elburg R, Schreurs M, Van Well G. Rituximab administration in third trimester of pregnancy suppresses neonatal B-cell development. Clin Dev Immunol. 2008;2008(1):1.

    Article  Google Scholar 

  71. Chakravarty EF, Murray ER, Kelman A, Farmer P. Pregnancy outcomes after maternal exposure to rituximab. Blood. 2011;117(5):1499–506.

    Article  CAS  PubMed  Google Scholar 

  72. Genentech. Ocrelizumab package insert. San Francisco: Genentech; 2017.

    Google Scholar 

  73. Vaidyanathan A, McKeever K, Anand B, Eppler S, Weinbauer GF, Beyer JC. Developmental immunotoxicology assessment of rituximab in cynomolgus monkeys. Toxicol Sci. 2010;119(1):116–25.

    Article  CAS  PubMed  Google Scholar 

  74. Hurley WL, Theil PK. Perspectives on immunoglobulins in colostrum and milk. Nutrients. 2011;3(4):442–74.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  75. Bragnes Y, Boshuizen R, de Vries A, Lexberg Å, Østensen M. Low level of Rituximab in human breast milk in a patient treated during lactation. Rheumatology. 2017;56(6):1047–8.

    Article  CAS  PubMed  Google Scholar 

  76. Oh J, Achiron A, Chambers C, et al. Pregnancy outcomes in patients with RRMS who received alemtuzumab in the clinical development program (S24. 008). Neurology. 2016;86(16 Supplement):S24.008.

    Google Scholar 

  77. Bove RM, Klein JP. Neuroradiology in women of childbearing age. Continuum Lifelong Learn Neurol. 2014;20(1):23–41.

    Article  Google Scholar 

  78. Argyriou AA, Makris N. Multiple sclerosis and reproductive risks in women. Reprod Sci. 2008;15(8):755–64.

    Article  PubMed  Google Scholar 

  79. Fraser F, Sajoo A. Teratogenic potential of corticosteroids in humans. Teratology. 1995;51(1):45–6.

    Article  CAS  PubMed  Google Scholar 

  80. Carmichael SL, Shaw GM. Maternal corticosteroid use and risk of selected congenital anomalies. Am J Med Genet A. 1999;86(3):242–4.

    Article  CAS  Google Scholar 

  81. Skuladottir H, Wilcox AJ, Ma C, et al. Corticosteroid use and risk of orofacial clefts. Birth Defects Res A Clin Mol Teratol. 2014;100(6):499–506.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  82. Bjørn A-MB, Ehrenstein V, Hundborg HH, Nohr EA, Sørensen HT, Nørgaard M. Use of corticosteroids in early pregnancy is not associated with risk of oral clefts and other congenital malformations in offspring. Am J Ther. 2014;21(2):73–80.

    Article  Google Scholar 

  83. Achiron A, Kishner I, Dolev M, et al. Effect of intravenous immunoglobulin treatment on pregnancy and postpartum-related relapses in multiple sclerosis. J Neurol. 2004;251(9):1133–7.

    Article  CAS  PubMed  Google Scholar 

  84. Webb JA, Thomsen HS, Morcos SK, Members of Contrast Media Safety Committee of European Society of Urogenital Radiology (ESUR). The use of iodinated and gadolinium contrast media during pregnancy and lactation. Eur Radiol. 2005;15(6):1234–40.

    Article  PubMed  Google Scholar 

  85. ACOG Committee on Obstetric Practice. ACOG committee opinion. number 299, September 2004 (replaces no. 158, September 1995). Guidelines for diagnostic imaging during pregnancy. Obstet Gynecol. 2004;104(3):647.

    Article  Google Scholar 

  86. Milgrom J, Gemmill AW, Bilszta JL, et al. Antenatal risk factors for postnatal depression: a large prospective study. J Affect Disord. 2008;108(1):147–57.

    Article  PubMed  Google Scholar 

  87. Feinstein A. Multiple sclerosis and depression. Mult Scler J. 2011;17(11):1276–81.

    Article  Google Scholar 

  88. Langer-Gould A, Beaber BE. Effects of pregnancy and breastfeeding on the multiple sclerosis disease course. Clin Immunol. 2013;149(2):244–50.

    Article  CAS  PubMed  Google Scholar 

  89. Hellwig K, Rockhoff M, Herbstritt S, et al. Exclusive breastfeeding and the effect on postpartum multiple sclerosis relapses. JAMA Neurol. 2015;72(10):1132–8.

    Article  PubMed  Google Scholar 

  90. Portaccio E, Ghezzi A, Hakiki B, et al. Breastfeeding is not related to postpartum relapses in multiple sclerosis. Neurology. 2011;77(2):145–50.

    Article  CAS  PubMed  Google Scholar 

  91. Pakpoor J, Disanto G, Lacey MV, Hellwig K, Giovannoni G, Ramagopalan SV. Breastfeeding and multiple sclerosis relapses: a meta-analysis. J Neurol. 2012;259(10):2246–8.

    Article  PubMed  Google Scholar 

  92. De Seze J, Chapelotte M, Delalande S, Ferriby D, Stojkovic T, Vermersch P. Intravenous corticosteroids in the postpartum period for reduction of acute exacerbations in multiple sclerosis. Mult Scler J. 2004;10(5):596–7.

    Article  Google Scholar 

  93. Cooper SD, Felkins K, Baker TE, Hale TW. Transfer of methylprednisolone into breast milk in a mother with multiple sclerosis. J Hum Lact. 2015;31(2):237–9.

    Article  PubMed  Google Scholar 

  94. Achiron A, Rotstein Z, Noy S, Mashiach S, Dulitzky M, Achiron R. Intravenous immunoglobulin treatment in the prevention of childbirth-associated acute exacerbations in multiple sclerosis: a pilot study. J Neurol. 1996;243(1):25–8.

    Article  CAS  PubMed  Google Scholar 

  95. Brandt-Wouters E, Gerlach OH, Hupperts RM. The effect of postpartum intravenous immunoglobulins on the relapse rate among patients with multiple sclerosis. Int J Gynecol Obstet. 2016;134(2):194–6.

    Article  CAS  Google Scholar 

  96. Bove R, Rankin K, Chua AS, et al. Oral contraceptives and MS disease activity in a contemporary real-world cohort. Mult Scler J. 2017; https://doi.org/10.1177/1352458517692420.

  97. Pozzilli C, De Giglio L, Barletta VT, et al. Oral contraceptives combined with interferon β in multiple sclerosis. Neurol-Neuroimmunol Neuroinflammation. 2015;2(4):e120.

    Article  Google Scholar 

  98. Vukusic S, Ionescu I, El-Etr M, et al. The prevention of post-partum relapses with progestin and estradiol in multiple sclerosis (POPART'MUS) trial: rationale, objectives and state of advancement. J Neurol Sci. 2009;286(1):114–8.

    Article  CAS  PubMed  Google Scholar 

  99. Durand-Dubief F, El-Etr M, Ionescu I, et al. The POPARTMUS French-Italian multicentric trial of postpartum progestin and estradiol in multiple sclerosis: MRI findings. Paper presented at: Multiple Sclerosis Journal 2014.

    Google Scholar 

  100. Haghmorad D, Amini AA, Mahmoudi MB, Rastin M, Hosseini M, Mahmoudi M. Pregnancy level of estrogen attenuates experimental autoimmune encephalomyelitis in both ovariectomized and pregnant C57BL/6 mice through expansion of Treg and Th2 cells. J Neuroimmunol. 2014;277(1):85–95.

    Article  CAS  PubMed  Google Scholar 

  101. Jansson L, Olsson T, Holmdahl R. Estrogen induces a potent suppression of experimental autoimmune encephalomyelities and collagen-induced arthritis in mice. J Neuroimmunol. 1994;53(2):203–7.

    Article  CAS  PubMed  Google Scholar 

  102. Sicotte NL, Liva SM, Klutch R, et al. Treatment of multiple sclerosis with the pregnancy hormone estriol. Ann Neurol. 2002;52(4):421–8.

    Article  CAS  PubMed  Google Scholar 

  103. Voskuhl RR, Wang H, Wu TJ, et al. Estriol combined with glatiramer acetate for women with relapsing-remitting multiple sclerosis: a randomised, placebo-controlled, phase 2 trial. Lancet Neurol. 2016;15(1):35–46.

    Article  CAS  PubMed  Google Scholar 

  104. Rizvi SA, Bashir K. Other therapy options and future strategies for treating patients with multiple sclerosis. Neurology. 2004;63(12 suppl 6):S47–54.

    Article  CAS  PubMed  Google Scholar 

  105. Lennon VA, Kryzer TJ, Pittock SJ, Verkman A, Hinson SR. IgG marker of optic-spinal multiple sclerosis binds to the aquaporin-4 water channel. J Exp Med. 2005;202(4):473–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  106. Matiello M, Schaefer-Klein J, Sun D, Weinshenker BG. Aquaporin 4 expression and tissue susceptibility to neuromyelitis optica. JAMA Neurol. 2013;70(9):1118–25.

    Article  PubMed  Google Scholar 

  107. Quek AM, McKeon A, Lennon VA, et al. Effects of age and sex on aquaporin-4 autoimmunity. Arch Neurol. 2012;69(8):1039–43.

    Article  PubMed  PubMed Central  Google Scholar 

  108. Marrie RA, Gryba C. The incidence and prevalence of neuromyelitis optica: a systematic review. Int J MS Care. 2013;15(3):113–8.

    Article  PubMed  PubMed Central  Google Scholar 

  109. Mealy MA, Wingerchuk DM, Greenberg BM, Levy M. Epidemiology of neuromyelitis optica in the United States: a multicenter analysis. Arch Neurol. 2012;69(9):1176–80.

    Article  PubMed  Google Scholar 

  110. Wingerchuk DM, Lennon VA, Lucchinetti CF, Pittock SJ, Weinshenker BG. The spectrum of neuromyelitis optica. Lancet Neurol. 2007;6(9):805–15.

    Article  CAS  PubMed  Google Scholar 

  111. Pandit L, Asgari N, Apiwattanakul M, et al. Demographic and clinical features of neuromyelitis optica: a review. Mult Scler J. 2015;21(7):845–53.

    Article  CAS  Google Scholar 

  112. Klawiter EC, Bove R, Elsone L, et al. High risk of postpartum relapses in neuromyelitis optica spectrum disorder. Neurology. 2017; https://doi.org/10.1212/WNL.0000000000004681.

  113. Kim W, Kim S-H, Nakashima I, et al. Influence of pregnancy on neuromyelitis optica spectrum disorder. Neurology. 2012;78(16):1264–7.

    Article  CAS  PubMed  Google Scholar 

  114. Fragoso YD, Adoni T, Bichuetti DB, et al. Neuromyelitis optica and pregnancy. J Neurol. 2013;260(10):2614–9.

    Article  PubMed  Google Scholar 

  115. Nour MM, Nakashima I, Coutinho E, et al. Pregnancy outcomes in aquaporin-4–positive neuromyelitis optica spectrum disorder. Neurology. 2016;86(1):79–87.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  116. Reichlin M. Systemic lupus erythematosus and pregnancy. J Reprod Med. 1998;43:355–60.

    CAS  PubMed  Google Scholar 

  117. Davoudi V, Keyhanian K, Bove RM, Chitnis T. Immunology of neuromyelitis optica during pregnancy. Neurol-Neuroimmunol Neuroinflammation. 2016;3(6):e288.

    Article  Google Scholar 

  118. Reuß R, Rommer PS, Brück W, et al. A woman with acute myelopathy in pregnancy: case outcome. London: BMJ Publishing Group; 2009.

    Google Scholar 

  119. Kimbrough DJ, Fujihara K, Jacob A, et al. Treatment of neuromyelitis optica: review and recommendations. Mult Scler Relat Disord. 2012;1(4):180–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  120. Jacob A, Weinshenker BG, Violich I, et al. Treatment of neuromyelitis optica with rituximab. Arch Neurol. 2008;65(11):1443–8.

    Article  PubMed  Google Scholar 

  121. Pellkofer H, Suessmair C, Schulze A, Hohlfeld R, Kuempfel T. Course of neuromyelitis optica during inadvertent pregnancy in a patient treated with rituximab. Mult Scler J. 2009;15(8):1006–8.

    Article  CAS  Google Scholar 

  122. Azim HA Jr, Azim H, Peccatori FA. Treatment of cancer during pregnancy with monoclonal antibodies: a real challenge. Expert Rev Clin Immunol. 2010;6(6):821–6.

    Article  PubMed  Google Scholar 

  123. Prunty M, Sharpe L, Butow P, Fulcher G. The motherhood choice: themes arising in the decision-making process for women with multiple sclerosis. Mult Scler J. 2008;14(5):701–4.

    Article  CAS  Google Scholar 

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  1. Department of Neurology, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA, USA

    Tamara B. Kaplan

  2. Department of Neurology, Weill Institute for the Neurosciences, University of California, San Francisco, CA, USA

    Riley Bove

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  1. Tamara B. Kaplan
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  2. Riley Bove
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Correspondence to Tamara B. Kaplan .

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  1. Department of Neurology, Brigham and Women’s Hospital, Boston, MA, USA

    Mary Angela O’Neal

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Kaplan, T.B., Bove, R. (2019). Demyelinating Disease and Pregnancy. In: O’Neal, M. (eds) Neurology and Psychiatry of Women. Springer, Cham. https://doi.org/10.1007/978-3-030-04245-5_17

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  • DOI: https://doi.org/10.1007/978-3-030-04245-5_17

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  • Print ISBN: 978-3-030-04244-8

  • Online ISBN: 978-3-030-04245-5

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