A brain disorder that causes inflammation in the central nervous system may increase a woman’s risk for miscarriage and preeclampsia, according to research published in Neurology.
Neuromyelitis optica (NMO) spectrum disorder, or Devic’s disease, is often confused for multiple sclerosis (MS) and affects mainly the spinal cord and the nerves to the eyes, although the brain may also be involved.
According to the National Institute for Neurological Disorders and Stroke (NINDS), NMO is an uncommon disease syndrome of the central nervous system (CNS).
Individuals with NMO develop optic neuritis – causing pain in the eye and vision loss – and transverse myelitis, which causes weakness, numbness and sometimes paralysis of the arms and legs, along with sensory disturbances and loss of bladder and bowel control.
Senior author Dr. Maria Isabel Leite, of the UK’s Oxford University, and colleagues studied 60 women with a history of at least one pregnancy and a diagnosis of neuromyelitis optica spectrum disorder (NMOSD). The participants were interviewed and their medical records reviewed.
Of the study participants, 40 were analyzed for miscarriages and 57 for preeclampsia, a life-threatening condition for both mother and baby, characterized by high blood pressure and protein in the urine during pregnancy.
Over the course of the retrospective study, of the 40 women with a diagnosis of NMO, there were 85 pregnancies. Of these, 13% ended in miscarriage; that is 11 pregnancies in six women. This percentage is similar to the rate in the general population. Miscarriage occurred in 43%, or 6 out of 14 pregnancies that occurred after the onset of the disease.
Pregnancies conceived up to 3 years before disease onset were nearly 12 times as likely to end in miscarriage, regardless of the mother’s age or history of miscarriage.
Women who experienced miscarriage within the year before the onset of disease also had more disease activity in the period starting 9 months before conception and lasting to the end of pregnancy, compared with viable pregnancies.
The rate of preeclampsia was 11.5% in women with NMO, significantly higher than the 3.1% reported in the general population. Preeclampsia was more prevalent in women who also had multiple other autoimmune disorders or miscarriage in the most recent previous pregnancy, but disease onset was not a risk factor.
According to Dr. Leite:
“Women with neuromyelitis optica have a high risk of miscarriage particularly in pregnancies occurring within the 3 years prior to, or after, when the disease starts. So unfortunately, some of these women may not even know they are going to have the disease at the time of miscarriage.”
Limitations with this study include the small sample size, the fact that patients were studied retrospectively and the lack of pathological data from placenta samples.
While Dr. Leite calls for larger studies to be carried out to confirm the findings, the study suggests a need to prevent disease activity prior to and during pregnancy in order to improve pregnancy outcomes in women with the condition.
Medical News Today reported on a treatment for preeclampsia that extends pregnancy, enabling the baby to mature.