{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T17:50:54Z","timestamp":1792000254238,"version":"4.4.0"},"reference-count":82,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2025,5,29]],"date-time":"2025-05-29T00:00:00Z","timestamp":1748476800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100008108","name":"Taipei Tzu-Chi Hospital","doi-asserted-by":"publisher","award":["TCRD-TPE-114-12"],"award-info":[{"award-number":["TCRD-TPE-114-12"]}],"id":[{"id":"10.13039\/501100008108","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Pregnancy orchestrates profound neurological, hormonal, and anatomical transformations in the maternal brain, preparing it for caregiving and infant bonding. Neuroimaging reveals structural changes such as gray matter reductions and white matter reorganization during pregnancy, followed by partial recovery postpartum. These adaptations are modulated by fluctuating levels of estradiol, progesterone, prolactin, and oxytocin, which coordinate neuroplasticity and behavioral readiness. At the molecular and cellular levels, pregnancy hormones drive synaptic remodeling, neurogenesis, and glial activity. Together, these changes support maternal motivation, attachment, and responsiveness, highlighting the maternal brain\u2019s dynamic plasticity across gestation and the postpartum period. Also, pregnancy induces profound physiological changes, particularly in vascular, hormonal, and neurologic systems, to support maternal and fetal health. While these adaptations are essential, they can predispose pregnant individuals to various neurologic and ophthalmic pathologies. This review explores how pregnancy-related changes\u2014including hypercoagulability, pituitary enlargement, hormonal fluctuations, and immunological modulation\u2014contribute to conditions such as stroke, idiopathic intracranial hypertension, preeclampsia-associated visual disturbances, and demyelinating disorders like neuromyelitis optica spectrum disorder and multiple sclerosis. Additionally, ocular manifestations of systemic diseases like diabetic retinopathy and thyroid orbitopathy are discussed. Understanding these complex interactions is critical for prompt recognition, accurate diagnosis, and appropriate management of vision-threatening and neurologically significant complications during pregnancy. Nevertheless, many aspects of physiological and pathological changes during and after pregnancy remain unknown and warrant further investigation.<\/jats:p>","DOI":"10.3390\/ijms26115220","type":"journal-article","created":{"date-parts":[[2025,5,29]],"date-time":"2025-05-29T07:46:26Z","timestamp":1748504786000},"page":"5220","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["The Molecular and Cellular Basis of Physiological Changes in Pregnancy and Its Implications in Neurologic and Ophthalmic Pathologies"],"prefix":"10.3390","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-6307-7839","authenticated-orcid":false,"given":"Yi-Ting","family":"Chiang","sequence":"first","affiliation":[{"name":"Department of Medical Education, Taipei Tzu-Chi Hospital, The Buddhist Tzu-Chi Medical Foundation, Taipei 231, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie-Hong","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Medicine, MacKay Medical College, New Taipei City 25245, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4758-0351","authenticated-orcid":false,"given":"Kuo-Hu","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Taipei Tzu-Chi Hospital, The Buddhist Tzu-Chi Medical Foundation, Taipei 231, Taiwan"},{"name":"School of Medicine, Tzu-Chi University, Hualien 970, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2143","DOI":"10.1002\/hbm.24513","article-title":"Pregnancy and Adolescence Entail Similar Neuroanatomical Adaptations: A Comparative Analysis of Cerebral Morphometric Changes","volume":"40","author":"Carmona","year":"2019","journal-title":"Hum. Brain Mapp."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1038\/nn.4458","article-title":"Pregnancy Leads to Long-Lasting Changes in Human Brain Structure","volume":"20","author":"Hoekzema","year":"2017","journal-title":"Nat. Neurosci."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1038\/s41583-023-00733-6","article-title":"The Transition to Motherhood: Linking Hormones, Brain and Behaviour","volume":"24","author":"Pretus","year":"2023","journal-title":"Nat. Rev. Neurosci."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2253","DOI":"10.1038\/s41593-024-01741-0","article-title":"Neuroanatomical Changes Observed over the Course of a Human Pregnancy","volume":"27","author":"Pritschet","year":"2024","journal-title":"Nat. Neurosci."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"104507","DOI":"10.1016\/j.psyneuen.2019.104507","article-title":"Becoming a Mother Entails Anatomical Changes in the Ventral Striatum of the Human Brain That Facilitate Its Responsiveness to Offspring Cues","volume":"112","author":"Hoekzema","year":"2020","journal-title":"Psychoneuroendocrinology"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1016\/j.cortex.2019.12.029","article-title":"From Baby Brain to Mommy Brain: Widespread Gray Matter Gain after Giving Birth","volume":"126","author":"Luders","year":"2020","journal-title":"Cortex"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"12","DOI":"10.33594\/000000105","article-title":"Postpartal Neural Plasticity of the Maternal Brain: Early Renormalization of Pregnancy-Related Decreases?","volume":"27","author":"Lisofsky","year":"2019","journal-title":"Neurosignals"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"6931","DOI":"10.1038\/s41467-022-33884-8","article-title":"Mapping the Effects of Pregnancy on Resting State Brain Activity, White Matter Microstructure, Neural Metabolite Concentrations and Grey Matter Architecture","volume":"13","author":"Hoekzema","year":"2022","journal-title":"Nat. Commun."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"4025","DOI":"10.1093\/cercor\/bhab463","article-title":"The Expectant Brain\u2014Pregnancy Leads to Changes in Brain Morphology in the Early Postpartum Period","volume":"32","author":"Chechko","year":"2022","journal-title":"Cereb. Cortex"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1037\/a0020884","article-title":"The Plasticity of Human Maternal Brain: Longitudinal Changes in Brain Anatomy during the Early Postpartum Period","volume":"124","author":"Kim","year":"2010","journal-title":"Behav. Neurosci."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1126\/science.adi0576","article-title":"Hormone-Mediated Neural Remodeling Orchestrates Parenting Onset during Pregnancy","volume":"382","author":"Ammari","year":"2023","journal-title":"Science"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1038\/s41586-018-0027-0","article-title":"Functional Circuit Architecture Underlying Parental Behaviour","volume":"556","author":"Kohl","year":"2018","journal-title":"Nature"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"16324","DOI":"10.1073\/pnas.1214094109","article-title":"siRNA Silencing of Estrogen Receptor-\u03b1 Expression Specifically in Medial Preoptic Area Neurons Abolishes Maternal Care in Female Mice","volume":"109","author":"Ribeiro","year":"2012","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"10779","DOI":"10.1073\/pnas.1708025114","article-title":"Prolactin Action in the Medial Preoptic Area Is Necessary for Postpartum Maternal Nursing Behavior","volume":"114","author":"Brown","year":"2017","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Numan, M. (2020). The Parental Brain: Mechanisms, Development, and Evolution, Oxford University Press.","DOI":"10.1093\/oso\/9780190848675.001.0001"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1016\/S0361-9230(01)00554-8","article-title":"Alterations of Medial Preoptic Area Neurons Following Pregnancy and Pregnancy-like Steroidal Treatment in the Rat","volume":"55","author":"Gerecke","year":"2001","journal-title":"Brain Res. Bull."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Uriarte, N., Ferre\u00f1o, M., M\u00e9ndez, D., and Nogueira, J. (2020). Reorganization of Perineuronal Nets in the Medial Preoptic Area During the Reproductive Cycle in Female Rats. Sci. Rep., 10.","DOI":"10.1038\/s41598-020-62163-z"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/j.yfrne.2016.02.004","article-title":"The Birth of New Neurons in the Maternal Brain: Hormonal Regulation and Functional Implications","volume":"41","author":"Leuner","year":"2016","journal-title":"Front. Neuroendocrinol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1126\/science.1076647","article-title":"Pregnancy-Stimulated Neurogenesis in the Adult Female Forebrain Mediated by Prolactin","volume":"299","author":"Shingo","year":"2003","journal-title":"Science"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.neurobiolaging.2019.01.021","article-title":"Early and Late Effects of Maternal Experience on Hippocampal Neurogenesis, Microglia, and the Circulating Cytokine Milieu","volume":"78","author":"Eid","year":"2019","journal-title":"Neurobiol. Aging"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"107950","DOI":"10.1016\/j.neuropharm.2020.107950","article-title":"Effect of Sertraline on Central Serotonin and Hippocampal Plasticity in Pregnant and Non-Pregnant Rats","volume":"166","author":"Pawluski","year":"2020","journal-title":"Neuropharmacology"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.neuroscience.2007.07.031","article-title":"Reproductive Experience Alters Hippocampal Neurogenesis During the Postpartum Period in the Dam","volume":"149","author":"Pawluski","year":"2007","journal-title":"Neuroscience"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1002\/hipo.20278","article-title":"Maternal Experience Inhibits the Production of Immature Neurons in the Hippocampus During the Postpartum Period Through Elevations in Adrenal Steroids","volume":"17","author":"Leuner","year":"2007","journal-title":"Hippocampus"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"803","DOI":"10.1016\/j.psyneuen.2007.05.012","article-title":"Early Motherhood in Rats Is Associated with a Modification of Hippocampal Function","volume":"32","author":"Maccari","year":"2007","journal-title":"Psychoneuroendocrinology"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1002\/hipo.22258","article-title":"Lactation-Induced Reduction in Hippocampal Neurogenesis Is Reversed by Repeated Stress Exposure","volume":"24","author":"Hillerer","year":"2014","journal-title":"Hippocampus"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1016\/j.neuropharm.2015.11.027","article-title":"Parity Modifies the Effects of Fluoxetine and Corticosterone on Behavior, Stress Reactivity, and Hippocampal Neurogenesis","volume":"105","author":"Workman","year":"2016","journal-title":"Neuropharmacology"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"718","DOI":"10.1160\/TH09-10-0704","article-title":"Haemostatic Reference Intervals in Pregnancy","volume":"103","author":"Szecsi","year":"2010","journal-title":"Thromb. Haemost."},{"key":"ref_28","first-page":"162","article-title":"Neuro-Ophthalmic Disorders in Pregnancy","volume":"20","author":"Digre","year":"2014","journal-title":"Continuum"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"213","DOI":"10.4274\/tjo.43815","article-title":"Pregnancy and the Eye","volume":"45","author":"Yenerel","year":"2015","journal-title":"Turk. J. Ophthalmol."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Anton, N., Bogd\u0103nici, C.M., Brani\u0219teanu, D.C., Armeanu, T., Ilie, O.D., and Doroftei, B. (2024). A Narrative Review on Neuro-Ophthalmological Manifestations That May Occur During Pregnancy. Life, 14.","DOI":"10.3390\/life14040431"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1097\/WNO.0b013e31823920cb","article-title":"Neuro-Ophthalmology and Pregnancy: What Does a Neuro-Ophthalmologist Need to Know?","volume":"31","author":"Digre","year":"2011","journal-title":"J. Neuroophthalmol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"58","DOI":"10.2174\/157016113804547638","article-title":"Stroke in Women\u2014Oral Contraception, Pregnancy, and Hormone Replacement Therapy","volume":"11","author":"Rantanen","year":"2013","journal-title":"Curr. Vasc. Pharmacol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/j.jsbmb.2013.02.008","article-title":"Progesterone, Inflammation and Preterm Labor","volume":"139","year":"2014","journal-title":"J. Steroid Biochem. Mol. Biol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/j.ncl.2018.09.001","article-title":"Neuro-Ophthalmic Disorders in Pregnancy","volume":"37","author":"Gilbert","year":"2019","journal-title":"Neurol. Clin."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"838","DOI":"10.21037\/qims-20-830","article-title":"Cerebrovascular Disease in Pregnancy and Puerperium: Perspectives from Neuroradiologists","volume":"11","author":"Wang","year":"2021","journal-title":"Quant. Imaging Med. Surg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1097\/GRF.0b013e31828f25fa","article-title":"Stroke and Pregnancy: Clinical Presentation, Evaluation, Treatment, and Epidemiology","volume":"56","author":"Grear","year":"2013","journal-title":"Clin. Obstet. Gynecol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1007\/s11102-020-01107-2","article-title":"Management of Sellar and Parasellar Tumors Becoming Symptomatic During Pregnancy: A Practical Algorithm Based on Multi-Center Experience and Systematic Literature Review","volume":"24","author":"Zoli","year":"2021","journal-title":"Pituitary"},{"key":"ref_38","first-page":"64","article-title":"Pituitary Dimensions and Volume Measurements in Pregnancy and Post Partum. MR Assessment","volume":"39","author":"Esen","year":"1998","journal-title":"Acta Radiol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1049","DOI":"10.1007\/s00417-006-0491-3","article-title":"Loss of Vision Due to a Physiologic Pituitary Enlargement During Normal Pregnancy","volume":"245","author":"Inoue","year":"2007","journal-title":"Graefes Arch. Clin. Exp. Ophthalmol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"e228323","DOI":"10.1136\/bcr-2018-228323","article-title":"Visual Loss in Pregnancy","volume":"12","author":"Bachmeier","year":"2019","journal-title":"BMJ Case Rep."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"66","DOI":"10.5468\/ogs.2014.57.1.66","article-title":"Developed diplopia and ptosis due to a nonfunctioning pituitary macroadenoma during pregnancy","volume":"57","author":"Lee","year":"2014","journal-title":"Obstet. Gynecol. Sci."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1258\/om.2012.120022","article-title":"Review of Presentation, Diagnosis and Management of Pituitary Tumours in Pregnancy","volume":"6","author":"Lambert","year":"2013","journal-title":"Obstet. Med."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1007\/s10143-016-0762-3","article-title":"Unique features of pregnancy-related meningiomas: Lessons learned from 148 reported cases and theoretical implications of a prolactin modulated pathogenesis","volume":"41","author":"Laviv","year":"2018","journal-title":"Neurosurg. Rev."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1515\/med-2017-0029","article-title":"Pathophysiology of meningioma growth in pregnancy","volume":"12","author":"Bencze","year":"2017","journal-title":"Open Med."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1097\/AOG.0b013e31827e6251","article-title":"Recurrent Exophytic Meningioma in Pregnancy","volume":"121","author":"Chow","year":"2013","journal-title":"Obstet. Gynecol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1707","DOI":"10.1038\/s41433-019-0461-8","article-title":"Serous retinal detachment in preeclampsia and malignant hypertension","volume":"33","author":"Lee","year":"2019","journal-title":"Eye"},{"key":"ref_47","first-page":"147","article-title":"Neuro-ophthalmology and Pregnancy","volume":"28","author":"Moss","year":"2022","journal-title":"Continuum"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1169","DOI":"10.1161\/STROKEAHA.108.527788","article-title":"Magnesium sulfate for the treatment of eclampsia: A brief review","volume":"40","author":"Euser","year":"2009","journal-title":"Stroke"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"2669","DOI":"10.1001\/jama.290.20.2669","article-title":"Effect of Magnesium Sulfate Given for Neuroprotection Before Preterm Birth: A Randomized Controlled Trial","volume":"290","author":"Crowther","year":"2003","journal-title":"JAMA"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1848","DOI":"10.1016\/0002-9378(90)90763-W","article-title":"Neuroophthalmologic effects of intravenous magnesium sulfate","volume":"163","author":"Digre","year":"1990","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Bain, E.S., Middleton, P.F., and Crowther, C.A. (2013). Maternal adverse effects of different antenatal magnesium sulphate regimens for improving maternal and infant outcomes: A systematic review. BMC Pregnancy Childbirth, 13.","DOI":"10.1186\/1471-2393-13-195"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1055\/s-0037-1607393","article-title":"Migraine in Women","volume":"37","author":"Broner","year":"2017","journal-title":"Semin. Neurol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"675","DOI":"10.1111\/head.12206","article-title":"Lifetime prevalence and correlates of migraine among women in a pacific northwest pregnancy cohort study","volume":"54","author":"Frederick","year":"2014","journal-title":"Headache"},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Chauvel, V., Schoenen, J., and Multon, S. (2013). Influence of ovarian hormones on cortical spreading depression and its suppression by L-kynurenine in rat. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0082279"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"858","DOI":"10.1016\/j.otohns.2007.09.009","article-title":"Bell\u2019s palsy and pregnancy","volume":"137","author":"Vrabec","year":"2007","journal-title":"Otolaryngol. Head. Neck Surg."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1097\/OGX.0000000000000732","article-title":"Bell\u2019s Palsy in Pregnancy","volume":"74","author":"Evangelista","year":"2019","journal-title":"Obstet. Gynecol. Surv."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"3015","DOI":"10.4103\/ijo.IJO_1377_21","article-title":"Diabetic retinopathy in pregnancy\u2014A review","volume":"69","author":"Chandrasekaran","year":"2021","journal-title":"Indian. J. Ophthalmol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1111\/j.1442-9071.2006.01413.x","article-title":"Progression of retinopathy during pregnancy in type 1 diabetes mellitus","volume":"35","author":"Rahman","year":"2007","journal-title":"Clin. Exp. Ophthalmol."},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"The Diabetes Control and Complications Trial Research Group (2000). Effect of pregnancy on microvascular complications in the diabetes control and complications trial. Diabetes Care, 23, 1084\u20131091.","DOI":"10.2337\/diacare.23.8.1084"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1007\/s11892-008-0048-4","article-title":"Does pregnancy accelerate the rate of progression of diabetic retinopathy?: An update","volume":"8","author":"Sheth","year":"2008","journal-title":"Curr. Diab. Rep."},{"key":"ref_61","unstructured":"Shumway, C.L., Patel, B.C., Tripathy, K., and De Jesus, O. (2025). Neuromyelitis Optica Spectrum Disorder (NMOSD). StatPearls, StatPearls Publishing."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"922","DOI":"10.1136\/jnnp-2012-302310","article-title":"Current concept of neuromyelitis optica (NMO) and NMO spectrum disorders","volume":"84","author":"Jacob","year":"2013","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1016\/S1474-4422(12)70133-3","article-title":"Aquaporin 4 and neuromyelitis optica","volume":"11","author":"Papadopoulos","year":"2012","journal-title":"Lancet Neurol."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1177\/1352458515572406","article-title":"Demographic and clinical features of neuromyelitis optica: A review","volume":"21","author":"Pandit","year":"2015","journal-title":"Mult. Scler."},{"key":"ref_65","first-page":"813","article-title":"Down-regulation of aquaporin 4 in human placenta throughout pregnancy","volume":"21","author":"Cobellis","year":"2007","journal-title":"In Vivo"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"2999","DOI":"10.4049\/jimmunol.1301483","article-title":"Neuromyelitis optica IgG causes placental inflammation and fetal death","volume":"191","author":"Saadoun","year":"2013","journal-title":"J. Immunol."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"2238","DOI":"10.1212\/WNL.0000000000004681","article-title":"High risk of postpartum relapses in neuromyelitis optica spectrum disorder","volume":"89","author":"Klawiter","year":"2017","journal-title":"Neurology"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"2614","DOI":"10.1007\/s00415-013-7031-y","article-title":"Neuromyelitis optica and pregnancy","volume":"260","author":"Fragoso","year":"2013","journal-title":"J. Neurol."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1212\/WNL.0b013e31824c466f","article-title":"Neuromyelitis optica and pregnancy","volume":"78","author":"Bourre","year":"2012","journal-title":"Neurology"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"1264","DOI":"10.1212\/WNL.0b013e318250d812","article-title":"Influence of pregnancy on neuromyelitis optica spectrum disorder","volume":"78","author":"Kim","year":"2012","journal-title":"Neurology"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"202","DOI":"10.3109\/01658107.2011.593676","article-title":"Pregnancy Associated Ischaemic Optic Neuropathy","volume":"35","author":"Koskela","year":"2011","journal-title":"Neuro-Ophthalmology"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1111\/ene.12797","article-title":"An overview of pregnancy-related issues in patients with multiple sclerosis","volume":"22","author":"Pozzilli","year":"2015","journal-title":"Eur. J. Neurol."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1177\/1352458513507816","article-title":"Predictors and dynamics of postpartum relapses in women with multiple sclerosis","volume":"20","author":"Hughes","year":"2014","journal-title":"Mult. Scler."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"790","DOI":"10.1111\/j.1471-0528.2011.02931.x","article-title":"What can we really tell women with multiple sclerosis regarding pregnancy? A systematic review and meta-analysis of the literature","volume":"118","author":"Finkelsztejn","year":"2011","journal-title":"Bjog"},{"key":"ref_75","first-page":"399","article-title":"Multiple sclerosis and pregnancy: Maternal considerations","volume":"8","author":"Alwan","year":"2012","journal-title":"Womens Health"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1093\/bmb\/ldq039","article-title":"Thyroid function in pregnancy","volume":"97","author":"Lazarus","year":"2011","journal-title":"Br. Med. Bull."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"2594","DOI":"10.1056\/NEJMcp0801880","article-title":"Graves\u2019 Disease","volume":"358","author":"Brent","year":"2008","journal-title":"N. Engl. J. Med."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1016\/j.siny.2006.04.003","article-title":"Immunology of normal pregnancy","volume":"11","author":"Silver","year":"2006","journal-title":"Semin. Fetal Neonatal Med."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"416739","DOI":"10.1155\/2012\/416739","article-title":"Changes in the Th1:Th2 cytokine bias in pregnancy and the effects of the anti-inflammatory cyclopentenone prostaglandin 15-deoxy-\u0394(12,14)-prostaglandin J2","volume":"2012","author":"Sykes","year":"2012","journal-title":"Mediat. Inflamm."},{"key":"ref_80","doi-asserted-by":"crossref","unstructured":"Bucci, I., Giuliani, C., and Napolitano, G. (2017). Thyroid-Stimulating Hormone Receptor Antibodies in Pregnancy: Clinical Relevance. Front. Endocrinol., 8.","DOI":"10.3389\/fendo.2017.00137"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"698470","DOI":"10.1155\/2015\/698470","article-title":"Relationship Between Clinical and Immunological Features of Thyroid Autoimmunity and Ophthalmopathy During Pregnancy","volume":"2015","author":"Wall","year":"2015","journal-title":"J. Thyroid Res."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"967","DOI":"10.1089\/thy.2006.16.967","article-title":"Study of Serum Antibodies against Three Eye Muscle Antigens and the Connective Tissue Antigen Collagen XIII in Patients with Graves\u2019 Disease with and without Ophthalmopathy: Correlation with Clinical Features","volume":"16","author":"Gopinath","year":"2006","journal-title":"Thyroid"}],"container-title":["International Journal of Molecular Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1422-0067\/26\/11\/5220\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:42:59Z","timestamp":1760031779000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1422-0067\/26\/11\/5220"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,29]]},"references-count":82,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,6]]}},"alternative-id":["ijms26115220"],"URL":"https:\/\/doi.org\/10.3390\/ijms26115220","relation":{},"ISSN":["1422-0067"],"issn-type":[{"value":"1422-0067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,29]]}}}