Patient's Query
Hello doctor,
I am 28 and was recently diagnosed with NMOSD. I am thinking about starting a family within the next year, but I am worried about the risks during pregnancy. Are there specific concerns for women with NMOSD when it comes to pregnancy and childbirth? Should I avoid certain medications if I plan to conceive soon? I am feeling scared, but I also do not want to wait too long. Please help.
Thank you.
Hi,
Welcome to icliniq.com.
I read your query and can understand your concern.
It is very good that you are planning ahead. Having neuromyelitis optica spectrum disorder (NMOSD, an autoimmune disorder) and wanting to start a family is absolutely possible, but it does require careful planning and close medical follow-up. Here is a detailed, easy-to-understand explanation:
1. Pregnancy and NMOSD risks:
Women with NMOSD, a condition where the body's immune system attacks the nerves of the eyes and spinal cord, can have successful pregnancies. However, there is a higher chance of relapse (a return or worsening of symptoms), especially after giving birth.
Possible risks include:
More relapses after delivery.
Early delivery (preterm birth), especially if relapses happen during pregnancy or if certain medications are used.
In rare cases, increased nerve damage or weakness if the disease is not well controlled.
2. Medication and pregnancy:
Some medicines used to control NMOSD are not safe during pregnancy because they can harm the baby or affect your ability to get pregnant. These medicines need to be stopped or changed before you conceive, but always under your doctor's supervision.
Medicines to avoid or adjust:
Mycophenolate mofetil and Methotrexate – These can cause birth defects and should be stopped well before trying to conceive.
Rituximab – This medicine may be used in some cases, depending on timing and your doctor's advice.
Azathioprine – This may be used during pregnancy, but only under close medical supervision.
Safer treatment options:
Steroids (for example, Prednisolone) in low doses help reduce inflammation and are generally safe during pregnancy.
IVIG (intravenous immunoglobulin) – A treatment made from donated antibodies that can help control the immune system during pregnancy.
Azathioprine – This may be allowed if needed, but only with a doctor's close watch.
Important: Never stop your medications suddenly. Always talk to your neurologist (nerve specialist) before making any changes.
3. Preconception planning (before you try to get pregnant):
Make sure your NMOSD is stable (no recent relapses) for at least six to 12 months.
Review all your medicines to make sure none of them can harm a baby.
Start folic acid and prenatal vitamins early; these will help your baby's brain and spinal cord develop properly.
4. Monitoring during pregnancy:
You will need a team of doctors:
A neurologist to manage NMOSD.
An obstetrician who is experienced with high-risk pregnancies.
An immunologist (a doctor who specializes in the immune system), if needed.
Steroids can be safely used if you have a relapse during pregnancy. Most women can have a normal vaginal delivery unless there are specific complications.
5. Postpartum period (after the baby is born):
The time after delivery is when your risk of relapse is highest.
Talk to your neurologist before delivery about a plan to prevent a relapse.
Have regular checkups, and seek help immediately if you notice any return of symptoms (such as blurred vision, weakness, or numbness).
Why this happens (probable causes):
NMOSD is an autoimmune disease, meaning your immune system mistakenly attacks healthy nerve tissue, especially in the eyes (optic nerves) and spinal cord.
Hormonal changes during and after pregnancy can affect how active the disease is.
Tests that may be needed:
Review of your MRI (magnetic resonance imaging of the brain and spine) and CSF (cerebrospinal fluid) tests.
Review of your current medications.
ANA (antinuclear antibody test) and anti-AQP4 (anti-aquaporin-4 antibody test) antibody tests – These check for specific immune system markers related to NMOSD.
Hormone tests like TSH (thyroid-stimulating hormone) and vitamin D levels.
Other conditions that may look similar:
Multiple sclerosis (MS) is another nerve disorder, but it usually shows different features on MRI. If you have a positive AQP4 antibody, MS is less likely.
Most likely diagnosis:
Stable NMOSD (in remission) with a possible risk of pregnancy-related relapse.
Pregnancy is not harmful, but careful monitoring is essential.
Treatment plan:
Stop or switch any medications that could harm the baby.
Continue a safe medication plan to control NMOSD.
Start prenatal vitamins early.
Arrange regular checkups with your full care team.
What you can do to stay well:
Avoid stress and infections, as they may trigger a relapse.
Watch for any changes in your vision or sensation.
Get vaccinated before pregnancy (for example, flu, COVID, or coronavirus disease).
Follow-up advice:
See your neurologist every four to six weeks before and after pregnancy.
Have an urgent checkup after delivery or if you notice any symptoms returning.
You are doing the right thing by asking these questions early. With proper care and planning, many women with NMOSD go on to have healthy pregnancies and healthy babies.
I hope this helps.
Please revert in case of further queries.
Thank you.
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