# Perinatal outcome in anti-NMDAr encephalitis during pregnancy—a systematic review with individual patients’ data analysis

## TL;DR

This study reviews the outcomes of pregnancies affected by anti-NMDAr encephalitis, highlighting risks to both mothers and fetuses and the impact on child neurodevelopment.

## Contribution

The study provides a systematic analysis of individual patient data to clarify perinatal outcomes in anti-NMDAr encephalitis during pregnancy.

## Key findings

- Pregnant women with anti-NMDAr encephalitis experienced spontaneous pregnancy loss, premature birth, and cesarean delivery.
- Fetal and neonatal complications were linked to maternal anti-NR1 antibody levels, including movement disorders and low birth weight.
- Neuropsychiatric issues in children were associated with pathogenic NMDAr antibodies in maternal or neonatal serum.

## Abstract

Anti-N-methyl-D-aspartate receptor (NMDAr) antibody encephalitis is an autoimmune disorder characterized by synaptic NMDAr current disruption and receptor hypofunction, often affecting women during pregnancy. Clinical manifestations associated with anti-NMDAr encephalitis can occur both in the mother and fetus.

We generated a systematic search of the literature to identify epidemiological, clinical, and serological data related to pregnant women with anti-NMDAr encephalitis and their children, analyzing the fetal outcomes. We examined the age and neurologic symptoms of the mothers, the presence of an underlying tumor, immunotherapies used during pregnancy, duration of the pregnancy, and type of delivery.

Data from 41 patients were extrapolated from the included studies. Spontaneous interruption of pregnancy, premature birth, and cesarean section were reported in pregnant women with NMDAr encephalitis. Several fetal and neonatal symptoms (e.g., movement disorders, spina bifida, poor sucking, respiratory distress, cardiac arrhythmias, infections, icterus, hypoglycemia, and low birth weight) depending on the mother’s serum anti-NR1 concentration were also reported.

We characterized the outcomes of children born from mothers with anti-NMDAr encephalitis, analyzing the pivotal risk factors related to pregnancy and maternal disorder. Neuropsychiatric involvement seems strictly related to pathogenic NMDAr antibodies detected in maternal and/or neonatal serum.

These findings clarify a complex condition to manage, outlining the risks associated with pregnant women with anti-NMDAr encephalitis and also providing a concrete guide for therapeutic strategies to prevent potential harm to the fetus and the child’s neurodevelopment.

The online version contains supplementary material available at 10.1007/s10072-024-07448-1.