Women with interstitial lung disease (ILD) are recommended to avoid pregnancy based on limited data. The study seeks to determine maternal and pregnancy outcomes in the largest-to-date cohort of patients with ILD.
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 were defined using PROMISSE-APO and Severe PROMISSE-APO criteria.
Among 86 pregnancies in 60 women, 85% women were Black, 71% had sarcoidosis, and 29% had connective tissue disease 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-APO 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-APO occurred in 15% of pregnancies, including 60% with very severe ILD and 28% with CTD-ILD. There were no maternal deaths. One woman required ICU stay during pregnancy. Three women had volume overload after delivery that resolved with medical management. Seven women received oxygen during delivery though none were intubated.
While adverse pregnancy outcomes were common in women with very severe ILD and underlying CTD, overall maternal morbidity and mortality was low. This data suggests women with ILD may be able to safely attempt pregnancy.