Safe Pregnancy Possible with Interstitial Lung Disease

Dr. Megan E.B. Clowse, M.D.

Women whose autoimmune disorders cause interstitial lung disease (ILD) may be able to get pregnant and give birth safely, researchers say.

“It’s time to rethink our approach to interstitial lung disease and pregnancy,” said Megan Clowse, M.D., MPH, an associate professor of medicine at Duke University. “Many women with ILD have been told they should never become pregnant, and for some that means they never become a mother.”

She presented the finding at the annual meeting of the American College of Rheumatology on Friday.

Clinicians often recommend that women with ILD avoid conception or terminate their pregnancies. But many women with ILD proceed with pregnancies anyway. So, Dr. Clowse and her colleagues reviewed the literature on the two conditions. “We were shocked to find there was almost no data on interstitial lung disease and pregnancy.”

And some of the studies that do exist were conducted when the care available was not as good as it is now, she added.

To fill that gap, the researchers reviewed medical records on 94 pregnancies in 67 patients diagnosed with ILD secondary to autoimmune disease at Duke University Health System from January 1996 to July 2019.

The patients’ average maternal age was 32.1, and 83% identified as Black. Overall, 69% of the pregnant patients were diagnosed with sarcoidosis, and 31% had a connective tissue disease-associated ILD. Of the 64 pregnancies with available data to classify their ILD severity, 11% were severe ILD, 25% were moderate ILD, 50% were mild ILD and 14% were normal.

All the pregnancies in the severe group had connective tissue disease-associated ILD, and 89% of the normal pregnancies had sarcoidosis. Seven of the pregnancies were conceived when the women were taking mycophenolate, a medication known to cause pregnancy loss and major birth defects.

Seventy percent of the pregnancies resulted in a live birth. Ten percent were terminated. Eighteen percent ended in miscarriage and 2% in stillbirth. Fifteen percent involved pre-eclampsia.

None of the women died. Although patients with severe ILD had more adverse pregnancy outcomes, only 2.1% of the patients required care in an ICU during or soon after delivery and 4.2% experienced significant shortness of breath due to increased fluid volume around the time of delivery. One patient developed postpartum heart failure. In eight pregnancies, the patient required oxygen during delivery and one patient was intubated mid-pregnancy for asthma.

In her own practice, Dr. Clowse said, she no longer recommends that patients with ILD avoid pregnancy. “By preventing that, we are changing the trajectories of their lives unnecessarily,” she said. Instead, she now counsels patients with ILD about the risks.

She added that patients on teratogenic immunosuppressives should to be switched over to pregnancy-compatible medications.

______________

REFERENCE

ABSTRACT: 1446. “Pregnancy Outcomes in Patients with Interstitial Lung Disease (ACR20).” The annual meeting of the American College of Rheumatology. 11:30 AM, Sunday, Nov. 8, 2020