Pregnancy Considerations for Women With Interstitial Lung Disease and an Autoimmune Condition

A retrospective medical records study for interstitial lung disease (ILD) has just been published in Arthritis Care & Research. The results found that for women diagnosed with ILD as well as an autoimmune condition, risk of adverse cardiorespiratory events during pregnancy as well as maternal mortality are low.

This is huge news because women with ILD were often told to avoid pregnancy due to increased risk. This team of researchers aimed to conduct the largest study to date on the topic to provide clearer data on risk. With more information, women can make a more informed choice on what to do with their bodies.

The Study

Records from this study came from Duke University. All patients in the study had both ILD and an autoimmune condition. Each individual was classified by severity of lung function based on pulmonary function tests (normal function, mild to moderate, severe, and very severe).

Adverse pregnancy outcomes assessed in this study included preeclampsia, fetal death after 12 weeks, neonatal death, preterm delivery (before 36 weeks), as well as small for gestational age. Severe criteria included neonatal death, preterm delivery before 34 weeks, preterm delivery before 30 weeks, and fetal death over 12 weeks.

60 women were included in the analysis and 86 pregnancies were evaluated. 59 of the women had pulmonary function tests to use for analysis. Of these, 12% of pregnancies were in women with very severe ILD (of these 1 individual had pre-pregnancy oxygen needs. This same woman did not need oxygen while giving birth.), 25% were in women with severe ILD, 51% were in women with mild to moderate ILD, and 12% were in women with normal pulmonary function.

71% of pregnancies were in women diagnosed with sarcoidosis, and 29% were in women diagnosed with connective tissue disease-associated ILD (CTD-ILD). Of those with CTD-ILD, 11 had systemic lupus erythematous, 3 had polymyositis, 3 had scleroderma, 2 had Sjögren’s syndrome, 2 had undifferentiated CTD, 2 had eosinophilic granulomatosis with polyangiitis, 1 had granulomatous polyangiitis, and 1 had lymphocytic interstitial pneumonia. Every woman with severe ILD had a CTD-ILD diagnosis. Additionally, 80% of those with a normal pulmonary function were diagnosed with sarcoidosis.

Negative pregnancy outcomes across all ranges of ILD severity were found in 32% of pregnancies. Negative outcomes were found in 56% of pregnancies for those diagnosed with CTD-ILD as well as 23% of those diagnosed with sarcoidosis.

Severe negative pregnancy outcomes were found in 15% of all pregnancies. Of those with severe ILD, 60% had severe negative outcomes. Additionally, of those with CTD-ILD, 28% had severe negative outcomes.

What it Means

These results demonstrate that women diagnosed with ILD may or may not experience severe pregnancy outcomes. Risk varies depending the severity of ILD as well as the type of accompanying autoimmune condition. Those diagnosed with very severe ILD and a significant rheumatic disease may be more likely to have negative outcomes in pregnancy.

For those diagnosed with ILD who are thinking about pregnancy, three things are important to remember.

First, pregnancy is likely to be associated with better outcomes when the ILD is well controlled and the patient is on medications which are compatible with pregnancy.

Second, women should be provided a preconception assessment as well as counseling.

Third, women with ILD should be monitored closely while they are pregnant, during delivery, and during postpartum.

You can read more about these considerations of pregnancy and ILD here.

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