Volume 75, Issue 5 p. 1166-1174
Original Article

Pregnancy Outcomes in Patients With Interstitial Lung Disease

Megan E. B. Clowse

Corresponding Author

Megan E. B. Clowse

Duke University School of Medicine, Durham, North Carolina

Address correspondence via email to Megan E. B. Clowse, MD, MPH, at [email protected].

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Aardra Rajendran

Aardra Rajendran

Duke University School of Medicine, Durham, North Carolina

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Amanda Eudy

Amanda Eudy

Duke University School of Medicine, Durham, North Carolina

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Stephanie Giattino

Stephanie Giattino

Main Line Health System, Wynnewood, Pennsylvania

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Aparna Swaminathan

Aparna Swaminathan

Duke University School of Medicine, Durham, North Carolina

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Andra H. James

Andra H. James

Duke University School of Medicine, Durham, North Carolina

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First published: 08 November 2021
Citations: 4

Dr. Rajendran's work was funded by the Rheumatology Research Foundation, Medical Student Research Preceptorship. Dr. Eudy's work was funded by the NIH National Center for Advancing Translational Sciences Award (1-KL-2-TR-002554).

Abstract

Objective

Women with interstitial lung disease (ILD) are recommended to avoid pregnancy based on limited data. This study seeks to determine maternal and pregnancy outcomes in the largest-to-date cohort of patients with ILD.

Methods

Medical records in the Duke University Health System were reviewed for pregnancies in patients with a diagnosis of ILD with underlying autoimmune disease. Pregnancies were classified as having very severe, severe, mild-moderate, or normal lung function based on pulmonary function tests (PFTs). Adverse pregnancy outcomes (APOs) were defined using the Predictors of Pregnancy Outcome in Systemic Lupus Erythematosus and Antiphospholipid Syndrome APO (PROMISSE-APO) and Severe PROMISSE-APO criteria.

Results

Among 86 pregnancies in 60 women, 85% women were Black, 71% had sarcoidosis, and 29% had connective tissue disease (CTD)–associated ILD (CTD-ILD). Of the pregnancies with available PFTs (n = 59), 12% had very severe ILD, 25% had severe ILD, 51% had mild-moderate ILD, and 12% had normal lung function.

PROMISSE-APOs occurred in 32% of pregnancies, including all pregnancies with very severe ILD (P = 0.02 across severity groups), 56% of pregnancies with CTD-ILD, and 23% with sarcoidosis (P = 0.02). Severe PROMISSE-APOs occurred in 15% of pregnancies, including 60% with very severe ILD and 28% with CTD-ILD. There were no maternal deaths. One woman required an intensive care hospital stay during pregnancy. Three women had volume overload after delivery that resolved with medical management. Seven women received oxygen during delivery, although none were intubated.

Conclusion

Although APOs were common in women with very severe ILD and underlying CTD, overall maternal morbidity and mortality were low. These data suggest women with ILD may be able to safely attempt pregnancy.