How Well Do Women with Sarcoidosis Handle Pregnancy?

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Sarcoidosis is what doctors call an autoimmune disease. This means a disease resulting from your immune system attacking certain body tissues, as if they were foreign to your body. It is a chronic disease, meaning long-term. In the United States, sarcoidosis is present in roughly 11 to 18 out of every 100,000 births people. Since the disease typically is diagnosed during early to middle age adulthood, you may be diagnosed around the time of pregnancy. African Americans have a prevalence 3 times that of Caucasians. Woman are affected somewhat more than men, and so African American women have the highest risk in the United States. Women of Scandinavian, Irish, German, and West Indies descent also have a fairly high prevalence of sarcoidosis. Obesity increases your risk of developing sarcoidosis. Smoking appears to reduce the risk of developing sarcoidosis, but there numerous reasons not to smoke whether you are pregnant or not.

Sarcoidosis is characterized by inflammation, with small lumps called, called granulomas affecting especially the lungs, lymph nodes, and skin. But sarcoidosis can affect any organ in the body. African American women also tend to have more organs involved compared with other women who have sarcoidosis. Sarcoidosis is a long-term disease, but pregnancy can influence the health implications, both in positive and negative ways. On one hand, if the disease has damaged organs, such as the lungs and heart, your organ function may deteriorate on account of the increased demands of pregnancy. As an example, the increasing volume of blood that you produce during pregnancy puts increased demands on your heart and kidneys. On the other hand, since pregnancy increases your levels of corticosteroids, hormones from the adrenal gland that do many things including oppose inflammation, the actual disease process causing inflammation with granulomas typically subsides as pregnancy advances.

Diagnosis of sarcoidosis depends on a combination of the clinical presentation (your history and physical examination results), imaging such as chest X-ray, computed tomography (CT) scanning, examination of tissues obtained through biopsies, laboratory tests on blood samples, such as a complete blood count (CBC), a comprehensive metabolic panel (CMP), and liver enzyme measurements. To check how well your heart is functioning, you also may be tested with electrocardiography (ECG), Holter monitoring, and echocardiography.

As we mentioned earlier, due to hormonal changes, it’s possible that the underlying disease process of sarcoidosis will subside during pregnancy. Pregnancy may actually make you feel better. But weighing against this possibility is the fact that sarcoidosis damages organs, such as the lungs and heart, the demands on which increase during pregnancy. This is how sarcoidosis and pregnancy interact for the mother, but what about the implications for the baby? The answer depends on the severity of the disease for the particular women. If there is lung damage, or heart damage, to the point that advancing pregnancy has a negative impact on heart or lung function, a woman suffering from sarcoidosis may have trouble carrying the baby to term. In some cases, termination of the pregnancy may be recommended.

As you may have guessed from our discussion of how pregnancy increases production of corticosteroids, which make the effects of sarcoidosis subside, the same kind of substances are given to patients with sarcoidosis. This is to inhibit the immune system, which is attacking body tissues. Of the various medicines that can inhibit the immune system, corticosteroids are the drugs that are given initially. Corticosteroids must be given carefully during pregnancy, but it is possible to carry out a pregnancy while taking them. For longer-term treatment in people with sarcoidosis, other agents are added, also to inhibit the immune system. Some of these agents, such as methotrexate, absolutely cannot be given during pregnancy, as they can terminate the pregnancy or cause severe birth defects. But many of the medications are being studied to determine their appropriateness for pregnant patients. Because pregnancy drives the production of your own corticosteroids, decreasing the severity of the disease, some woman actually can receive reduced dosages of their normal sarcoidosis medicines.

Often, women are able to breastfeed while taking corticosteroids, but it means that you need to pump out your milk a few hours after receiving your steroid dose, discard what you have pumped, and then wait for more milk to fill and use that to feed the baby. This may not leave you with enough milk, so you may need to supplement with formula. Or you may chose simply to avoid breastfeeding and use formula alone.

David Warmflash
Dr. David Warmflash is a science communicator and physician with a research background in astrobiology and space medicine. He has completed research fellowships at NASA Johnson Space Center, the University of Pennsylvania, and Brandeis University. Since 2002, he has been collaborating with The Planetary Society on experiments helping us to understand the effects of deep space radiation on life forms, and since 2011 has worked nearly full time in medical writing and science journalism. His focus area includes the emergence of new biotechnologies and their impact on biomedicine, public health, and society.

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