Department of Neurology, Hôpital Charles Nicolle, Rouen, France.
Neurology. 2012 Mar 20;78(12):875-9. doi: 10.1212/WNL.0b013e31824c466f. Epub 2012 Mar 7.
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.
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.
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).
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.
我们研究的目的是评估妊娠对视神经脊髓炎（NMO）病程的影响，以及硬膜外镇痛和母乳喂养对产后其活动的影响。
我们对根据 Wingerchuk 标准诊断的 NMO 患者进行了回顾性研究。我们记录了妊娠前一年（BP）、妊娠期间（第一、二、三孕期）和产后一年（Y + 1：第一、二孕期[PP2]和第三、四季度）的复发次数。记录了硬膜外镇痛和母乳喂养情况。残疾情况采用 Kurtzke 扩展残疾状态量表（EDSS）进行评估。计算了年复发率（ARR）。
我们在 2010 年 11 月 1 日的法国 NOMADMUS 队列中确定了 124 名患者（85 名女性）。共有 20 名女性（包括 25 次妊娠）的档案完整，信息完整。与 BP（1.0 ± 0.09）相比，每个时期的 ARR 比较仅显示 PP2 有增加趋势（0.8 ± 0.06，p = 0.07）。硬膜外镇痛和母乳喂养对 NMO 的病程没有影响。EDSS 评分从 BP 的 1.5 ± 1.7 增加到 Y + 1 的 2.6 ± 1.9（p = 0.027）。
本研究表明妊娠会影响 NMO 的活动，这一发现证明需要密切的医学监测。我们没有证据表明硬膜外镇痛或母乳喂养会加重 NMO。
