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[多发性硬化症和视神经脊髓炎谱系障碍女性的计划生育]

[Family Planning in Women Diagnosed with Multiple Sclerosis and Neuromyelitis Optica Spectrum Disorder].

作者信息

Shimizu Yuko

机构信息

Department of Medical Safety, Tokyo Women's Medical University School of Medicine.

出版信息

Brain Nerve. 2023 Sep;75(9):1005-1014. doi: 10.11477/mf.1416202463.

Abstract

Multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) are two prevalent autoimmune diseases of the central nervous system that predominantly affect women during childbearing age. Patients of childbearing age affected by conditions, such as MS and NMOSD, should consider the potential implications of pregnancy. The selection of treatment options should be carefully evaluated, considering preconception care and assessing the risk-benefit profile for both the mother and fetus. In recent years, there has been growing interest and need to address pregnancy and delivery in the context of these diseases, leading to the development of several internationally reported guidelines. The management of MS and NMOSD has entered a new era in Japan, with the inclusion of monoclonal antibodies and various biological agents, including B-cell depletion therapy, which is covered by insurance. Furthermore, there has been increasing focus on myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), which has been reported to be associated with pregnancy. In this article, we aim to discuss the characteristics of MS, NMOSD, and MOGAD in the context of pregnancy, while providing updated insights on managing pregnancy and lactation with disease-modifying drugs and biologic agents.

摘要

多发性硬化症(MS)和视神经脊髓炎谱系障碍(NMOSD)是两种常见的中枢神经系统自身免疫性疾病,主要影响育龄期女性。患有MS和NMOSD等疾病的育龄期患者应考虑怀孕的潜在影响。治疗方案的选择应仔细评估,考虑孕前护理并评估对母亲和胎儿的风险效益概况。近年来,在这些疾病背景下处理妊娠和分娩的兴趣和需求不断增加,导致制定了多项国际报告的指南。在日本,MS和NMOSD的管理进入了一个新时代,纳入了单克隆抗体和各种生物制剂,包括保险覆盖的B细胞清除疗法。此外,人们越来越关注髓鞘少突胶质细胞糖蛋白抗体相关疾病(MOGAD),据报道该疾病与妊娠有关。在本文中,我们旨在讨论MS、NMOSD和MOGAD在妊娠背景下的特征,同时提供关于使用疾病修饰药物和生物制剂管理妊娠和哺乳的最新见解。

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