Current evidence and knowledge gaps in family planning and pregnancy in myasthenia gravis, NMOSD, and MOGAD
Issued Date
2026-03-01
Resource Type
eISSN
14744465
Scopus ID
2-s2.0-105030785961
Pubmed ID
41722595
Journal Title
Lancet Neurology
Volume
25
Issue
3
Start Page
308
End Page
324
Rights Holder(s)
SCOPUS
Bibliographic Citation
Lancet Neurology Vol.25 No.3 (2026) , 308-324
Suggested Citation
Rotstein D.L., Alroughani R., Arrambide G., Contentti E.C., Chomba M., Fujihara K., Gilhus N.E., Gouider R., Heckmann J.M., Kim H.J., Li H.F., Leite M.I., Monif M., Siritho S., Thiel S., Vishnevetsky A., Viswanathan S., Vukusic S., Yamout B., Kümpfel T., Hellwig K. Current evidence and knowledge gaps in family planning and pregnancy in myasthenia gravis, NMOSD, and MOGAD. Lancet Neurology Vol.25 No.3 (2026) , 308-324. 324. doi:10.1016/S1474-4422(25)00479-X Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/115479
Title
Current evidence and knowledge gaps in family planning and pregnancy in myasthenia gravis, NMOSD, and MOGAD
Author's Affiliation
University of Oxford
Massachusetts General Hospital
Monash University
University of Toronto Faculty of Medicine
University of Cape Town
Klinikum der Universität München
Mahidol University
CHU de Lyon
Haukeland Universitetssjukehus
Fukushima Medical University
Xuanwu Hospital, Capital Medical University
National Cancer Center, Gyeonggi
Faculté de Médecine de Tunis
Kuala Lumpur Hospital
Hospital Aleman
University of Zambia School of Medicine
Al-Amiri Hospital
Katholisches Klinikum Bochum
Neurology Institute
Multiple Sclerosis Centre of Catalonia
Massachusetts General Hospital
Monash University
University of Toronto Faculty of Medicine
University of Cape Town
Klinikum der Universität München
Mahidol University
CHU de Lyon
Haukeland Universitetssjukehus
Fukushima Medical University
Xuanwu Hospital, Capital Medical University
National Cancer Center, Gyeonggi
Faculté de Médecine de Tunis
Kuala Lumpur Hospital
Hospital Aleman
University of Zambia School of Medicine
Al-Amiri Hospital
Katholisches Klinikum Bochum
Neurology Institute
Multiple Sclerosis Centre of Catalonia
Corresponding Author(s)
Other Contributor(s)
Abstract
Myasthenia gravis, neuromyelitis optica spectrum disorder (NMOSD), and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) are antibody-mediated neuroimmune disorders that frequently affect women in their reproductive years and require careful treatment planning around pregnancy. Disease exacerbations (for myasthenia gravis) and attacks (for NMOSD and MOGAD) can occur during pregnancy, are common postpartum, and can cause preventable, long-term maternal disability. Many drug labels are conservative or recommend unnecessary prolonged washouts or avoidance of breastfeeding, creating uncertainty for physicians and patients. This Personal View integrates available evidence on conventional immunosuppressants and biological therapies, including complement inhibition, B-cell depletion, and neonatal Fc receptor blockade. Although data on pregnancy safety for newer treatments are few, preliminary data suggest that selected therapies could be continued during pregnancy to maintain disease stability and are compatible with breastfeeding. We offer expert recommendations for therapy choice, infant vaccinations, and fetal and infant monitoring in myasthenia gravis, NMOSD, and MOGAD.