Can NMOSD affect future pregnancies in a 32-year old?

Question

Hello doctor,

I am really scared because my 32-year-old daughter was just diagnosed with NMOSD after having vision problems and numbness in her legs for the past three months. It started right after she had her first baby, and we thought it was just postpartum fatigue at first.

Her aquaporin-4 antibody test came back positive, and MRI showed lesions on her optic nerve and spinal cord. The neurologist put her on Rituximab infusions every six months, but she had to stop breastfeeding, which made her really depressed.

During her last relapse, she lost vision in her left eye for two weeks and could not feel anything below her waist. The IV steroids helped, but left her with terrible mood swings and insomnia. She was on birth control pills before pregnancy, but the doctor said estrogen might trigger more NMOSD attacks.

Now she is scared to have another baby because pregnancy might make the neuromyelitis optica worse. Her husband does not really understand how serious this condition is and thinks she is being dramatic about the symptoms. Can NMOSD affect future pregnancies? Also, are there safer immunosuppressive drugs she can take while trying to conceive?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I can understand your concern.

Her husband must meet with the neurologist to learn more about NMOSD (neuromyelitis optica spectrum disorder), as this is a serious condition, and family support plays a big role. I do not think she should rush for another pregnancy until her disease is stable. NMOSD can relapse in the third trimester and after delivery, so right now her condition must become stable.

It is safest to try for another baby only when her NMOSD has been stable for at least 12 months (no relapses for a year).

Women with NMOSD can have a higher chance of problems like high blood pressure in pregnancy, miscarriage, early delivery, or the baby not growing as expected. Some medicines are unsafe in pregnancy (like Methotrexate, Mycophenolate). But relatively safer options do exist, such as Azathioprine and steroids.

Rituximab may be continued in select cases, but this requires individualized decision-making between the patient and her doctors. Since she is already on Rituximab, your doctors will decide if continuing is the best option for her. A few studies suggest that estrogen might impact NMOSD, but there is no strong evidence.

Intrauterine devices (IUDs) are also a good contraceptive choice because they have no whole-body effects, but infections should be ruled out before use.

I hope this information will help you.

Kindly follow up if you have more concerns.

Thank you.