Pregnancy Registry, Infants, Serum/Milk Analysis (PRISMA)

PRISMA, is a pregnancy registry study, focused on comprehensively collecting information about pregnancy in women with chronic neurological conditions from across the United States and internationally.

Depending on their specific condition (MS, CIS, NMOSD, or other) and their specific treatment, participants will be asked to contribute to different aspects of the study. (1) The biosamples will be blood, breast milk, infant stool, and maternal stool samples, collected at specific time points. (2) The online surveys will be collected at specific time points. All study activities will be discussed with participants upon enrollment.

By collecting this information, the investigators hope to gain deeper insights into the relationship between pregnancy, the neurological condition, and maternal and infant health. For example, one of the sub-studies focuses on breast milk collection for women planning postpartum treatment with Ocrevus, Rituxan, Briumvi or Kesimpta.

This study is fully remote and all sample collection is optional, so participants can choose which types of samples they wish to provide. For blood draws, participants can schedule a home visit through \*\*ExamOne\*\*, making participation even more convenient.

The investigators aim to enroll women with chronic neurological conditions who are planning pregnancy, currently pregnant, or within one year postpartum.

The aim of this project is to develop a repository of samples for women who are pregnant and have chronic conditions, including demyelinating diseases -- either multiple sclerosis (MS), clinically isolated syndrome (CIS) or NMOSD (neuromyelitis optica spectrum disorders), chronic inflammation --- inflammatory bowel disease (IBD), rheumatoid arthritis (RA), lupus, myasthenia gravis (MG), primary headache disorders, or other chronic neurological conditions. Please note that the investigators refer to "MS" in the rest of the application.

This repository will include:

Maternal Outcomes (disease-related outcomes, depression, social support, breastfeeding and pregnancy-related outcomes):

Obtained via interviews, surveys, and medical record review during pregnancy planning, pregnancy (Baseline and 36w gestation) and postpartum (1, 4, 8, 12M) Maternal radiographic information will be collected from data available in the medical records. \[Radiographic information will be information captured from the medical record, not obtained during the study visits. No radiology exams will be conducted as part of this research study. If deemed necessary for the subject's routine clinical care, the investigators will record the results of an MRI within 12M postpartum.\] Infant Outcomes (growth, development, immunization, infection, breastfeeding, etc.) Obtained via medical record review (up to 12M) Monitored via maternal completion of the Ages and Stages Questionnaires-Version 3 (ASQ3) to track infant development outcomes (communication, gross motor, fine motor, problem solving, and person-social) at 2, 4, 6, 8, 10, and 12M of age.

Biospecimen Collection, Storage \& Later Batch Analysis:

Maternal blood samples will be collected for up to the following time points: Baseline (including if planning pregnancy), 3M gestation, 6M gestation, 8M gestation, 1M postpartum, 3M postpartum, and 6M postpartum. Samples will be processed and stored as serum, plasma and peripheral blood mononuclear cells (PBMCs).

Serial breastmilk samples will be collected, for bother before and post treatment if applicable, and up to 2-3 years postpartum. These samples will be used to determine the concentrations of medications in breastmilk relative to maternal serum.

Serial maternal and infant gut microbiome samples will be collected before and after treatment (anytime during the lactation period which can extend up to 2-3 years postpartum) to determine the effect of mAb treatment on gut microbial populations in mothers and infants. Mothers will be asked to complete food frequency questionnaires for themselves and their infants at the time of each sample collection.

Serial maternal blood samples will be collected (including before and post treatment) anytime up to 2-3 years postpartum. These samples will be used to determine concentrations of medications in breastmilk relative to serum and to determine the effect of maternal treatment on mother and infant gut microbiomes.

\* Timing of sample collection for participants treated with mAb will depend on the treatment type, dosing and infusion schedule.

Participants who are healthy controls or who are not receiving specific medications of interest will provide

* a single breastmilk sample at between 2-4M postpartum
* a maternal and infant gut microbiome sample at 2-4M postpartum Maternal blood samples will be collected at corresponding timepoints 2-4M postpartum (to be processed and stored as serum, plasma, and PBMCs)

Eligibility Criteria:
Inclusion Criteria:

* Pregnant or contemplating pregnancy
* Female, aged 18 to 64 years
* Diagnosis of one of the following conditions:
* Clinically Isolated Syndrome (CIS) or Multiple Sclerosis (MS), based on the 2010 McDonald Criteria
* Neuromyelitis Optica Spectrum Disorder (NMOSD)
* Inflammatory Bowel Disease (IBD)
* Rheumatoid Arthritis (RA)
* Myasthenia Gravis
* Lupus
* Other chronic neurological conditions
* Willing to provide biosamples and/or complete surveys at specified timepoints
* Women without a chronic condition who are pregnant or contemplating pregnancy (as part of the control group)

Exclusion Criteria:

- Unwillingness to provide informed consent