Is pregnancy safe for someone living with NMOSD?

Question

Hello doctor,

I am 29 and was diagnosed with NMOSD (neuromyelitis optica spectrum disorder) six months ago after losing vision in my left eye. A recent relapse affected my spinal cord, causing three weeks of numbness from the chest down. I am on Rituximab every six months, but my AQP4 (aquaporin‐4) antibodies remain positive.

My husband and I have been trying to conceive for two years. My neurologist warned that pregnancy might trigger more relapses, so I am unsure if it is safe to continue trying.

Additional concerns:

Heavy, prolonged periods (up to nine days) with large clots.
Weekly double vision, affecting driving and work.
Depression since diagnosis; currently on Sertraline, but worried about interactions with NMOSD treatment.

I would appreciate your advice on:

Should I pause trying to conceive due to NMOSD risks?
Are my menstrual and visual symptoms treatment- or disease-related?
Is Sertraline safe with Rituximab and NMOSD?
How can I better manage symptoms and improve my quality of life?

Thank you for your guidance.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query, and I understand your concerns about pregnancy with NMOSD, and I will try to explain simply.

Pregnancy with NMOSD (neuromyelitis optica spectrum disorder) is possible, but timing and planning are very important. It is safest to conceive when your disease has been stable for at least 12 months. Since you had a recent relapse, it is best to wait until things are more stable.

There is a higher risk of NMOSD flare-ups during the third trimester and especially after childbirth. Pregnancy can also carry added risks such as preeclampsia, miscarriage, preterm birth, or the baby not growing well. That is why close monitoring by both your neurologist and a high-risk obstetrician is essential.

You are currently on Rituximab, which has shown mixed data in pregnancy. Some doctors are cautious, while others consider it relatively safe if NMOSD (neuromyelitis optica spectrum disorder) is active. Whether to continue it during pregnancy depends on your disease severity and must be decided by your care team.

Medications like Methotrexate or Mycophenolate are not safe in pregnancy and need to be stopped well in advance.

With careful coordination between your neurologist and OB (Obstetrics), many women with NMOSD (neuromyelitis optica spectrum disorder) can have healthy pregnancies. For now, focus on achieving disease stability before trying to conceive.

I hope this answers your query.

Please let me know if I can assist you further.

Thank you.