"It's time to rethink our approach to interstitial lung disease and pregnancy. Many women with ILD have been told they should never become pregnant, and for some that means they never become a mother," Dr. Megan Clowse of Duke University in Durham, North Carolina, said at a November 6 press briefing at ACR Convergence, the 2020 annual virtual meeting of the American College of Rheumatology.
In reviewing the literature on ILD in pregnancy, "we were shocked" to find almost no data, Dr. Clowse said. Some of the studies that do exist were conducted decades ago when the care available was not as good as it is now, she added.
To fill the gap, the study team reviewed the electronic medical records for 67 women (mean age, 32 years) with 94 pregnancies (five twin pregnancies) complicated by ILD secondary to autoimmune disease. Most of the women were Black (83%), 69% had sarcoidosis, and 31% had a connective-tissue disease related to ILD.
The researchers were able to classify 64 pregnancies according to the severity of ILD based on two standard breathing tests (forced vital capacity and diffusion capacity for carbon monoxide, with cutoff values that were normal (14%), mild (50%), moderate (25%) and severe (11%).
Overall, 70% of the pregnancies resulted in a live birth, 10% were terminated, 18% ended in miscarriage and 2% in stillbirth. Pre-eclampsia complicated 15% of pregnancies. Only one woman delivered early and she had severe ILD and severe lupus nephritis.
Commenting on the results in a Rheumatology Network podcast (https://bit.ly/38lu6bZ), Dr. Fotios Koumpouras, director of the Yale lupus program, in New Haven, Connecticut, said, "This is new data to suggest that perhaps this patient population may not suffer the morbidity that we initially thought."
The study, he added, provides "emerging data guidance of when (these) pregnancies can be successful."
Dr. Clowse said, "The health of the mother is what drives a lot of our pregnancy decisions for these patients and we were pleasantly surprised to find that there were no deaths in this cohort of pregnancies."
"In addition, only two of the women were admitted to the intensive-care unit during their pregnancies. In one, it was mid-pregnancy for an asthma flare related to her vasculitis. In the other, it was around the time of delivery, and she had lung failure and shortness of breath due to volume overload. An additional three women also had volume overload around the time of delivery and required diuretics and were quite short of breath for a several day period of time, but all these patients recovered well," she reported.
"For women who had normal up to moderate lung disease, they really had remarkably good outcomes, pretty comparable to the general population," Dr. Clowse told the briefing.
"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," she added in a conference statement.
Dr. Clowse said pregnancies complicated by ILD should be managed at a tertiary-care center by a multidisciplinary team.
"We pretty aggressively treat inflammation and rheumatic disease during pregnancy. There are multiple pregnancy-compatible medications that will treat ILD and we recommend using those in order to control inflammation and ultimately scarring," she told the briefing.
"We also recommend monitoring these pregnancies very closely, both during the pregnancy, but then also after delivery. We currently recommend at Duke that these patients with moderate or severe disease stay in the hospital for up to a week just for monitoring so that we can help them through the major physiologic changes that happen after delivery," Dr. Clowse added.
The study had no specific funding and the authors have no relevant disclosures.
By Megan Brooks
SOURCE: https://bit.ly/2In9Rjg and https://bit.ly/2GS8cSA ACR Convergence 2020, presented November 6, 2020.
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