Background/Purpose: Currently published data regarding pregnancy outcomes in patients with interstitial lung disease (ILD) related to autoimmune disease and sarcoidosis is limited, with widely variant outcomes reported. Some guidelines even suggest that these patients must avoid or terminate pregnancy. This study aimed to retrospectively analyze the pregnancy outcomes in a cohort of patients with ILD to help inform our ability to counsel patients on decision-making surrounding pregnancy and to help guide our management throughout pregnancy.

Methods: Medical records from 1/1/1996-9/27/2017 were retrospectively searched for encounters at our center for ICD-9/10 codes associated with pregnancy and ILD, including sarcoidosis. Each chart was reviewed to corroborate the diagnosis of lung disease, confirm that it temporally preceded the pregnancy, and ensure availability of delivery outcomes. Patients were categorized into two groups: sarcoidosis and autoimmune-related ILD (AI-ILD). Differences in categorical variables were analyzed using Fisher’s Exact Test, and continuous variables were analyzed using ANOVA or Wilcoxon rank-sum test.

Results: Of 631 patient charts reviewed, 62 unique patients with 89 pregnancies (5 twins) met inclusion criteria; 63 pregnancies with sarcoidosis (62% biopsy-proven) and 26 with AI-ILD (11 SLE, 1 RA, 3 SSc, 3 PM, 2 SS, 2 EGPA, 2 UCTD, 2 CTD-ILD). The cohort was predominantly black (84.3%), with mean maternal age of 32 years.

In total, there were 62 live births (Table 1), of which 11 were preterm (17.7%). Women in 8 pregnancies (12.9%) required oxygen at the time of delivery; however, only 1 (1.6%) required labor induction for maternal lung disease, and no patients required intubation. Two required ICU stays and no women died. Women with AI-ILD had more preeclampsia, but otherwise had similar pregnancy outcomes to those with sarcoidosis. Minimal differences in pregnancy outcomes and maternal morbidity were found when women with severe lung disease by imaging and/or pulmonary function tests were compared to those mild disease. Women with total lung capacity (TLC) <65% predicted more often required oxygen at delivery and had more C-sections, while women with diffusion capacity (DLCO) <60% predicted had no pregnancy outcome differences compared to women with better levels. The rate of pregnancy termination was similar for women with severe lung disease compared to overall (9.6% and 11.2%, respectively). While black women comprised >90% of the severe subgroups, pregnancy outcomes were similar when compared to non-black women with similar severity.

Conclusion: Pregnancies in women with AI-ILD and especially with sarcoidosis appear to be well tolerated from a pulmonary perspective, even in those with more severe disease by imaging and pulmonary function tests. Our data suggest is it not necessary for these women to avoid or terminate desired pregnancies due to lung disease alone.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/pregnancy-outcomes-in-patients-with-interstitial-lung-disease-related-to-autoimmune-disease-and-sarcoidosis/