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OBJECTIVE: To analyze the effects of pregnancy on neuromyelitis optica spectrum disorder (NMOSD) according to patients' serostatus and immunosuppressive therapy (IST). METHODS: We performed a retrospective multicenter international study on patients with NMOSD. Patients were tested for aquaporin-4 (AQP4) and myelin oligodendrocyte glycoprotein (MOG) antibodies (Ab). Informative pregnancies were reported when NMOSD onset occurred before or during pregnancy or up to 12 months postpartum (PP). The mean annualized relapse rate (ARR) was calculated for the 12 months before conception, for each trimester of pregnancy and PP. Events such as miscarriage, abortion and preeclampsia were reported. IST was considered if taken in the 3 months before or during pregnancy. RESULTS: We included 89 pregnancies (46 with AQP4-Ab, 30 with MOG-Ab and 13 without either Ab) in 58 NMOSD patients. Compared to the pre-pregnancy period, the ARR was lower during pregnancy in each serostatus group and higher during the PP period in patients with AQP4-Ab (p<0.01). Forty-eight percent (n = 31) of pregnancies occurred during IST and these patients presented fewer relapses during pregnancy and the 12 months PP than untreated patients (26% vs 53%, p = 0.04). Miscarriages occurred in 10 (11%) pregnancies, and were mainly in patients with AQP4-Ab (with or without IST) and a previous history of miscarriage. Preeclampsia was reported in two (2%) patients who were AQP4-Ab positive. CONCLUSION: We found a rebound in the ARR during the first PP trimester that was higher than the pre-pregnancy period only in AQP4-Ab-positive patients. Taking IST just before or during pregnancy reduces the risk of relapses in these conditions.

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