Dr Nayomi Perera1, Dr John Zhu2, Dr Freya Berenyi2, Dr Sarah Price1, Dr Jyotika Prasad2,3
1Department of Obstetric Medicine, Royal Women's Hospital, Parkville, Australia, 2Department of Respiratory Medicine, Royal Melbourne Hospital, Parkville, Australia, 3Department of Respiratory, Alfred Hospital, Melbourne, Australia
Biography:
Nayomi is currently an Obstetric Medicine Fellow at the Royal Women's Hospital. She has completed her training in Endocrinology and General Medicine
Abstract:
Introduction/Aim: Interstitial lung disease (ILD) can affect females of reproductive age, especially connective tissue disease ILD (CTD-ILD). Due to pulmonary fibrosis impairing gas exchange, it is thought that pregnant patients with ILD may not meet the increased oxygen demand required during pregnancy, potentially resulting in adverse maternal and fetal outcomes. Concomitant CTD may increase the risk of hypertension or pre-eclampsia. For these reasons ILD patients are often counselled not to conceive or proceed with pregnancy. We present a case series of pregnant patients with ILD managed at a tertiary hospital in Australia.
Method: Data were extracted to identify pregnant individuals with ILD between 1st Jan 2018 to 1 May 2024. Data collected included demographics, disease severity markers, maternal and fetal outcomes.
Results: We identified 8 patients with ILD who experienced pregnancies between January 1st, 2018, and May 1st, 2024. Two additional patients were identified as currently pregnant and will be included in the analysis upon completion of their pregnancies. Among the cohort, 6 individuals had CTD-ILD, 1 had lymphoid interstitial pneumonia, and 1 had chronic eosinophilic pneumonia. Three patients experienced antenatal complications, including pre-eclampsia. Two patients developed acute respiratory distress syndrome, with 1 requiring intubation. Among the 8 patients, 1 patient suffered a fetal death in utero; this pregnancy was complicated by maternal pre-eclampsia, respiratory distress and placental abruption. Of the 7 live births, 5 were delivered via emergency caesarean section, and 4 were preterm births. Five neonates were classified as small for gestational age, with 1 neonate experiencing respiratory distress. Two babies were born at term with normal birth weight, these mothers had no antenatal complications.
Conclusion: In our case series of pregnant women with ILD, 25% experienced respiratory deterioration, half required medically indicated preterm delivery and there was one fetal death.
Keywords
Interstitial lung disease