Management of interstitial lung disease in pregnancy: a case series

Interstitial lung disease (ILD) in pregnancy is associated with poor maternal and fetal outcomes in non-sarcoidosis cohorts. In this case series, we highlight the management of pregnant women with ILD. We identified five women through the Royal Melbourne Hospital ILD Clinic who had pregnancies between 1st January 2018 and 30th September 2023. Four patients had connective tissue disease-assoicated ILD (CTD-ILD) and one patient had eosinophilic pneumonia. (Table 1). Four had known ILD prior to pregnancy and one was diagnosed antenatally. None had pulmonary hypertension. Corticosteroids were given to four patients, two of whom required pulsed methylprednisolone. Hydroxychloroquine was given to all patients with CTD-ILD and azathioprine for three of these patients. Mepolizumab was used as salvage therapy for eosinophilic pneumonia. This patient required intubation. Postpartum disease-modifying therapy was unchanged for three women, however two were commenced on Mycophenolate and one on Rituximab following delivery. All five women had live births. Four deliveries were by emergency caesarean section and one by elective caesarean section. Pre-term delivery occurred in three patients for fetal distress and one for maternal deterioration. One patient required exertional oxygen at 2L/min on discharge and one required long-term oxygen therapy at 3-4L/min. <table-wrap><object-id>erj;64/suppl_68/PA703/TB1</object-id><object-id>T1</object-id><object-id>TB1</object-id><table><colgroup><col></col><col></col><col></col><col></col><col></col><col></col></colgroup><tbody><tr><td>Patient</td><td>Age</td><td>Pregnancies</td><td>Condition</td><td>FVC</td><td>DLCO</td></tr><tr><td>1</td><td>38</td><td>G2P1</td><td>CTD-ILD (MCTD)</td><td>1.35L (46%)</td><td>4.71L (25%)</td></tr><tr><td>2</td><td>35</td><td>G9P3-1</td><td>CTD-ILD (antisynthetase syndrome)</td><td>1.93L (56%)</td><td>10.10L (38%)</td></tr><tr><td>3</td><td>39</td><td>G3P3</td><td>Chronic eosinophilic pneumonia</td><td>1.87L (45%)</td><td>6.01L (21%)</td></tr><tr><td>4</td><td>40</td><td>G1P1</td><td>CTD-ILD (scleroderma)</td><td>1.57L (37%)</td><td>7.93L (31%)</td></tr><tr><td>5</td><td>33</td><td>G2P2</td><td>CTD-ILD (polymyositis)</td><td>11.25L (47%)</td><td>3.89L (68%)</td></tr></tbody></table></table-wrap> Table 1: Baseline demographics.