Devic syndrome and pregnancy: A case series

BACKGROUND: Devic syndrome or neuromyelitis optica is an autoimmune neurological condition characterized by relapsing symptoms of optic neuritis and transverse myelitis. Women with neuromyelitis optica suffer from adverse pregnancy outcomes and high relapse rates during pregnancy and the postpartum period. METHODS: This case series describes 13 pregnancies in four women with neuromyelitis optica managed at a tertiary hospital in Toronto, Canada. RESULTS: In most cases, neurologic symptoms either worsened or developed for the first time during pregnancy or the postpartum period, and often responded to a combination of steroids, immunosuppressant medications, plasma exchange and intravenous immunoglobulin. The 13 pregnancies resulted in two miscarriages, three preterm and eight term births. One fetus whose mother was on gabapentin, prednisone and spironolactone, had congenital malformations (aplastic lung and fused fingers). CONCLUSIONS: Despite high frequency of relapses in pregnancy and the postpartum period, with multidisciplinary team management, outcomes for women with neuromyelitis optica are encouraging.