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Abstract
Objective: The purpose of our study was to assess the influence of pregnancy on the course of neuromyelitis optica (NMO) and the impact of epidural analgesia and breastfeeding on its activity in the postpartum period.
Methods: We performed a retrospective study of patients with NMO diagnosed according to Wingerchuk criteria. We noted the number of relapses during the year before pregnancy (BP), during pregnancy (first trimester, second trimester, third trimester), and the year after (Y + 1: first trimester, second trimester [PP2], and third and fourth trimesters postpartum). Epidural analgesia and breastfeeding were recorded. Disability was evaluated with the Kurtzke Expanded Disability Status Scale (EDSS). The annualized relapse rate (ARR) was calculated.
Results: We identified 124 patients (85 female) in the French NOMADMUS cohort on November 1, 2010. A total of 20 women (including 25 pregnancies) were informative with complete files. Comparisons between the ARR of each period and BP (1.0 ± 0.09) only showed an increased tendency for PP2 (0.8 ± 0.06, p = 0.07). Epidural analgesia and breastfeeding had no influence on the course of NMO. The EDSS score increased from 1.5 ± 1.7 BP to 2.6 ± 1.9 Y + 1 (p = 0.027).
Conclusion: This study shows that pregnancy influences the activity of NMO, a finding that justifies close medical monitoring. We found no evidence to suggest that either epidural analgesia or breastfeeding has an aggravating effect on NMO.
GLOSSARY
- ARR=
- annualized relapse rate;
- BP=
- before pregnancy;
- EDMUS=
- European Database for MS;
- EDSS=
- Expanded Disability Status Scale;
- IgG=
- immunoglobulin G;
- MS=
- multiple sclerosis;
- NMO=
- neuromyelitis optica;
- NOMADMUS=
- European Database for MS adapted to neuromyelitis optica specificities;
- PP1=
- first trimester postpartum;
- PP2=
- second trimester postpartum;
- PP3=
- third trimester postpartum;
- PP4=
- fourth trimester postpartum;
- Y + 1=
- year after pregnancy.
Footnotes
Editorial, page 846
See also page 867
Supplemental data at www.neurology.org
Coinvestigators are listed on the Neurology® Web site at www.neurology.org.
- Received June 8, 2011.
- Accepted September 29, 2011.
- Copyright © 2012 by AAN Enterprises, Inc.
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