Current evidence and knowledge gaps in family planning and pregnancy in myasthenia gravis, NMOSD, and MOGAD
Journal: The Lancet Neurology; March 1, 2026
Author(s): Dalia L Rotstein, Raed Alroughani, Georgina Arrambide, Edgar Carnero Contentti, Mashina Chomba, Kazuo Fujihara, Nils E Gilhus, Riadh Gouider, Jeannine M Heckmann, Ho Jin Kim, Hai-Feng Li, Maria Isabel Leite, Mastura Monif, Sasitorn Siritho, Sandra Thiel, Anastasia Vishnevetsky, Shanthi Viswanathan, Sandra Vukusic, Bassem Yamout, Tania Kümpfel, Kerstin Hellwig
Managing pregnancy and family planning in patients with myasthenia gravis, NMOSD, and MOGAD
Because autoimmune conditions like myasthenia gravis (MG), NMOSD, and MOGAD often affect women during their reproductive years, patients and doctors must carefully consider disease treatment before, during, and after pregnancy. In this paper, researchers reviewed the available evidence on how family planning, pregnancy, and breastfeeding should be managed for patients under treatment for these three conditions.
During pregnancy, especially after delivery, symptoms of MG can worsen and NMOSD and MOGAD relapses can occur. These episodes can cause lasting disability, making it important to keep the disease under control throughout pregnancy and after childbirth.
However, the instructions provided with many treatments for these conditions recommend long gaps between stopping treatment and becoming pregnant. They may also advise patients to avoid breastfeeding. According to the authors, some of this guidance may be overly cautious and can lead to unnecessary treatment interruptions, uncertainty, and a greater risk of relapses and flare ups.
Although there is still limited information about the use of newer treatments during pregnancy, early evidence suggests that some treatments may be continued to keep the disease in check during pregnancy and possibly even through breastfeeding, when needed.
The authors provide recommendations to help doctors and patients choose treatments and plan monitoring of the baby and mother during pregnancy and after delivery. They also discuss the health and vaccination of babies who might have been exposed to these treatments.
Overall, pregnancy planning should carefully balance the possible risks that treatment may pose to the baby with the potentially serious risks of stopping treatment for MG, NMOSD, or MOGAD.
Related article: Analysis of Pregnancy-Related Attacks in Neuromyelitis Optica Spectrum Disorder. A Systematic Review and Meta-Analysis
Free Access: Abstract only