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Myelin oligodendrocyte glycoprotein antibody–associated disease (MOGAD) is a distinct inflammatory demyelinating disorder. Pregnancy is considered an immunotolerant; most studies suggest that the relapse rate of demyelinating diseases decreases during pregnancy , with increased relapse rates postpartum. Nonetheless, MOGAD can present for the first time during pregnancy, creating diagnostic and therapeutic dilemmas.

We retrospectively reviewed three MOG-IgG–positive patients from two tertiary centers who presented for the first time during pregnancy or the postpartum period. We summarized  clinical phenotype, MRI, acute treatments, disease-modifying therapy (DMT), and obstetric outcomes.

Three patients  with confirmed MOG-IgG-associated disease were identified across two tertiary centers. 2 patients presenting with a new diagnosis of MOGAD  for the first time during pregnancy  and 1 patients presenting in postpartum period.

 Out of a total of four clinical episodes , two episodes were optic neuritis and the remaining two presentations were transvers myelitis  . One of these patients subsequently relapsed five weeks postpartum. Visual outcomes were favorable overall, with recovery to 20/30 or better following immunotherapy.

MOG-IgG titers were ≥1:100 in all; MRI findings demonstrated longitudinally extensive spinal cord lesions in two patients , and bilateral T2 hyperintensities of intra- orbital segments of the optic nerve in another.

Pregnancy complications were seen in 2  patients including  fetal distress requiring urgent cesarean section at 33 + 6 weeks  and intrauterine growth restriction (IUGR) with cesarean delivery at 31 weeks. One patient experienced a miscarriage in subsequent pregnancy  at 6 weeks followed by an additional  pregnancy complicated by gestational diabetes and preterm cesarean delivery.

arean at 35+1 weeks.

This case series highlights an understudied population presenting with new-onset MOGAD during the peripartum period. MOGAD should remain in the differential diagnosis of inflammatory demyelinating events in pregnancy. Prompt diagnosis and therapy are crucial for maximizing recovery, and further research is needed to clarify the relationship between MOGAD and obstetric outcomes.