Pregnancy Well-Tolerated in Women With Sarcoidosis, Autoimmune Interstitial Lung Disease

Researchers conclude that it is not necessary for women with these conditions to avoid or terminate desired pregnancies, as was previously thought

Women with autoimmune interstitial lung disease (AI-ILD) and sarcoidosis do not need to avoid pregnancy due to lung disease alone, a new study finds. Even in women with more severe lung disease, pregnancy appears to be well-tolerated. These findings challenge recommendations that women with AI-ILD should avoid or terminate pregnancy. This is the largest study to date examining pregnancy outcomes in women with lung disease related to rheumatologic conditions, the authors said.

Stephanie L. Giattino, MD, a rheumatologist at Penn Medicine University City in Philadelphia, PA, presented outcomes of the study at the 2018 American College of Rheumatology and Association of Rheumatology Health Professionals held on October 19 to 24 in Chicago, IL. Co-authors Amanda M. Eudy, MD, and Megan E.B. Clowse, MD, MPH, are rheumatologists at Duke University School of Medicine in Durham, NC.

In normal pregnancy, hormonally mediated chest-wall changes compensate for a mild reduction in total lung capacity due to uterine enlargement and diaphragm elevation. However, the effects of pregnancy on lung function in women with restrictive lung diseases, such as AI-ILD and sarcoidosis, have been poorly defined. “Despite only having sparse and antiquated data regarding pregnancy outcomes in this group, many medical providers caution patients with severe restrictive lung disease to avoid pregnancy or even advise termination,” the authors explained. 

To better define pregnancy outcomes in this population, Giattino and colleagues retrospectively reviewed medical records of patients with AI-ILD and sarcoidosis who became pregnant. They identified 62 unique women with 89 pregnancies (5 sets of twins) diagnosed with lung disease that preceded pregnancy. Of these, there were 63 pregnancies in women with sarcoidosis (diagnosis proven by biopsy in 62%) and 26 with AI-ILD. The mean maternal age was 32 with a range of ages from 18 to 42. Women with sarcoidosis were significantly older than those with AI-ILD (mean 33.4 years vs 28.5, P = .0003).

Among those with AI-ILD, a substantial proportion had systemic lupus erythematosus (N = 11). Other autoimmune diseases in this cohort included rheumatoid arthritis, systemic sclerosis, polymyositis, undifferentiated connective tissue disease, isolated connective tissue disease ILD, eosinophilic granulomatosis with polyangiitis, and primary Sjögren syndrome.

Women with AI-ILD were significantly more likely than those with sarcoidosis to be taking disease modifying antirheumatic drugs (DMARDs). Overall, nearly 60% of women had severe lung disease, defined as fibrosis on chest imaging, total lung capacity (TLC) less than 65% predicted, and/or diffusion capacity of carbon monoxide (DLCO) less than 60% predicted. The majority of women were black or African American (approximately 84%), but comprised more than 90% of women with severe lung disease.

There were 62 live births, of which 17.7% were preterm. However, miscarriage and preterm birth rates were comparable to Center for Disease Control and Prevention estimates for the general population, the authors noted. A minority of infants (22.6% overall) were considered small for gestational age (defined as less than the tenth percentile for age at delivery). 

Women with AI-ILD were more likely to have preeclampsia than those with sarcoidosis (29.4% vs 6.5%, P = .02). Otherwise, labor and delivery complications were similar between the two groups. Approximately 13% of women required oxygen at delivery, but only one woman required labor induction for maternal lung disease and no women required intubation. Women with TLC less than 65% predicted were more likely to require oxygen at delivery. Surprisingly, women with DLCO less than 60% predicted had no pregnancy outcome differences compared to women with better DLCO function. Cesarean section deliveries were performed in approximately 60% of pregnancies. 

An analysis of pregnancy outcomes by severity of lung disease revealed no differences in outcomes. Pregnancy termination rates were similar for women, regardless of the severity of lung disease, decreasing the likelihood that data did not reflect outcomes of women with the most severe lung disease due to increases in medical termination.  

The authors concluded that pregnancies in women with AI-ILD and especially sarcoidosis appear to be well-tolerated and confer minimal complications, even in those with severe lung disease, suggesting it is not necessary for these women to avoid or terminate desired pregnancies due to lung disease alone.

Source: Giattino SL, Eudy AM, and Clowse ME. Pregnancy outcomes in patients with interstitial lung disease related to autoimmune disease and sarcoidosis. Presented at: 2018 ACR/ARHP Annual Meeting; October 19-24; Chicago, IL. Abstract 2422.