Is pregnancy contraindicated in patients with sarcoidosis?

Pregnancy in Patients with Sarcoidosis: Management and Considerations

Pregnancy is generally not contraindicated in women with sarcoidosis, except in cases of severe organ dysfunction such as respiratory failure, pulmonary hypertension, or significant cardiac involvement. 1

Disease Activity and Pregnancy Planning

Pre-Pregnancy Assessment

• Assess disease activity and organ involvement before conception
• Pregnancy should be planned during periods of disease quiescence/low activity 2
• Specific contraindications to pregnancy in sarcoidosis include:
  • Respiratory failure
  • Pulmonary hypertension
  • Vital capacity less than 1000 mL
  • Severe cardiac involvement
  • Active central nervous system disease 1

Medication Considerations

• Switch to pregnancy-compatible medications before conception:
  • Corticosteroids are the mainstay of therapy during pregnancy if treatment is needed 1
  • Discontinue contraindicated medications:
    • Methotrexate (teratogenic, particularly between 6-8 weeks gestation)
    • Antimalarial drugs (potential risk of congenital anomalies) 1

Management During Pregnancy

Monitoring Recommendations

• Clinical and radiological follow-up throughout pregnancy 3
• Laboratory assessment of disease activity at least once per trimester 2
• Monitor for potential complications:
  • Fetal growth restriction (reported in some cases) 3
  • Disease exacerbation (though uncommon during pregnancy)

Disease Course During Pregnancy

• Sarcoidosis typically follows one of three patterns during pregnancy:
  1. Improvement (less common)
  2. Stabilization (most common)
  3. Worsening (less common) 3
• Pregnancy itself does not generally aggravate sarcoidosis 1

Treatment During Pregnancy

• Continue necessary treatment for active disease
• Corticosteroids remain the first-line therapy during pregnancy 1
• For patients with SLE-associated sarcoidosis:
  • Consider hydroxychloroquine (HCQ) if benefits outweigh risks 2
  • Low-dose aspirin (81-100mg daily) may be considered if there are risk factors for preeclampsia 2, 4

Postpartum Considerations

Risk of Flare

• Increased risk of disease flare 3-6 months postpartum 1, 3
• Continue close monitoring for at least one year after delivery
• Four relapses and two cases of preliminary disease signs were observed in the first year postpartum in one study 3

Special Considerations

Cardiac Sarcoidosis

• Patients with cardiac sarcoidosis require special attention
• Cardiac involvement increases risk of morbidity and mortality 2
• Echocardiography and other cardiac monitoring may be necessary during pregnancy

Pulmonary Function

• Active pulmonary sarcoidosis with reduced lung function (FEV1 < 80% predicted) may increase risks during pregnancy 2
• Patients with resolved sarcoidosis and normal pulmonary function can generally proceed with pregnancy safely 2

Conclusion

Most women with sarcoidosis can have successful pregnancies with appropriate monitoring and management. The key is to plan pregnancy during periods of disease stability, avoid teratogenic medications, and maintain vigilant monitoring, particularly in the postpartum period when disease flares are more common.