Pregnancy and antibody-mediated diseases: evidence and gaps

Antibody-mediated neuroimmunological diseases, such as myasthenia gravis, neuromyelitis optica spectrum disorder (NMOSD), and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) frequently affect women during their reproductive years. Yet, counselling around family planning and pregnancy for people with these conditions has long been characterised by uncertainty and therapeutic hesitation. The systematic exclusion of women of childbearing age, including those who are pregnant, from clinical trials is rooted in legitimate safety concerns following historical tragedies, such as thalidomide use in the 1950s and 1960s. 1 However, this approach has resulted in enduring evidence gaps. Consequently, clinicians and patients are routinely required to make complex treatment decisions in the context of few disease-specific, prospective data.