Safe Pregnancy Is Possible for Women With ILD, Study Finds

A new study revealed that pregnant women with interstitial lung disease (ILD) may be able to have safe and viable pregnancies despite having an increased risk of adverse outcomes as a result of the disease.

The results of the study, presented at the American College of Rheumatology’s annual meeting, found that close monitoring and consultations with multidisciplinary physicians before, during, and after pregnancy can help ensure that pregnancy termination isn’t necessary.

Pregnancy is often avoided or even terminated in patients with ILD because of limited published data on pregnancy complications. Patients with ILD experience tissue inflammation in the lungs, leading to stiffening of the lung walls and severe breathing challenges for patients. ILD may also be associated with other autoimmune diseases, such as scleroderma, lupus, and sarcoidosis.

“Our hope is that patients with ILD and their providers can have more open and honest conversations on pregnancy risks, likely allowing more women living with ILD to safely create the families they desire,” the study’s co-author, Megan Clowse, MD, MPH, associate professor of Medicine for the Division of Rheumatology and Immunology at Duke University School of Medicine in Durham, North Carolina, said in a statement.

The study enrolled 67 female patients with ILD and 94 pregnancies. Five women had twin pregnancies. Overall, 69% of pregnancies were diagnosed with sarcoidosis and the remaining 31% were diagnosed with connective tissue disease associated ILD (CTD-ILD).

In 64 pregnancies, measures to classify ILD severity were available and 11% were severe , 25% were moderate, 50% were mild, and 14% were normal. All of the pregnancies classified as severe had CTD-ILD and 89% of those in the normal group had sarcoidosis (P < .001).

“Women with ILD who are considering pregnancy should discuss their individual risks for pregnancy and disease-related complications with their rheumatologist, pulmonologist, high-risk obstetrician and/or other specialists prior to stopping contraceptive measures,” said Clowse.

In the end, 70% of the pregnancies resulted in live births and 10% had to be terminated. The rate of pre-eclampsia was 15%. Adverse outcomes were defined using 2 scores: PROMISSE-APO and PROMISSE-APO SEVERE. These scores define adverse pregnancy outcomes based on pre-eclampsia, preterm delivery, infants small for their gestational age, fetal death and neonatal death. PROMISSE-APO occurred at a 30% rate and PROMISSE-APO SEVERE occurred at a rate of 15%, with patients with severe ILD having the highest rate among the groups (P = .03).

No maternal deaths occurred and only 2 pregnancies needed care from an intensive care unit. Volume load was experiences at the time of delivery in 4 pregnancies, of which 1 patient developed postpartum heart failure. Oxygen at time of delivery was needed in 8 pregnancies, and 1 patient had to be intubated during pregnancy.

Clowse recommended that in order for patients to decrease the risk of pregnancy loss and birth defects, patients on teratogenic immunosuppressives should be switched to medications that are safer to take during pregnancy prior to becoming pregnant.

“By planning pregnancy, we hope that women with stable ILD can have safer and healthier outcomes. In the future, work needs to be done to confirm these findings in other centers. Additionally, developing best practices in the clinical setting will likely increase the ability of women living with ILD to have safe pregnancies and healthy babies,” said Clowse.

Reference

Giattino S, Eudy A, Swaminathan A, Clowse M. Pregnancy outcomes in patients with interstitial lung disease. Presented at: ACR Convergence 2020; November 5-9, 2020; Abstract 1446. https://acrabstracts.org/abstract/pregnancy-outcomes-in-patients-with-interstitial-lung-disease/