Skip to main content
SpringerLink
Log in

Pulmonary Complications of Collagen Vascular Disease in Pregnancy

  • Chapter
  • First Online:
Pulmonary Problems in Pregnancy

Part of the book series: Respiratory Medicine ((RM))

Collagen vascular diseases (CVD) are a heterogeneous group of chronic auto-immune diseases frequently complicated by pulmonary involvement. The respiratory system may be involved in any of its components: airways, pleura, parenchyma, vessels, or respiratory muscles. However, interstitial lung disease and pulmonary hypertension (PH) are the most severe complications. CVD often affects childbearing women, thus management of pregnant women with collagen vascular disease is likely to occur. The presence of underlying pulmonary disease can present a significant challenge during the pregnancy and post-partum period. However, few studies or case reports describing pulmonary diseases associated with CVD are reported during pregnancy. The manifestations most frequently reported are related to vascular involvement, mainly thrombosis and PH. The effect of pregnancy on respiratory manifestations is often controversial. However, pulmonary involvement during CVD is rarely responsible for acute respiratory distress or for deleterious fetal or maternal outcomes. Patients with CVD and with severe interstitial lung disease (vital capacity < 1 L) or with PH should be advised to avoid pregnancy or consider therapeutic termination for maternal indications.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 249.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Doria A, Cutolo M, Ghirardello A, et al. Steroid hormones and disease activity during pregnancy in systemic lupus erythematosus. Arthritis Rheum 2002;47:202–209.

    Article  PubMed  CAS  Google Scholar 

  2. Weetman AP. The immunology of pregnancy. Thyroid 1999;9:643–646.

    Article  PubMed  CAS  Google Scholar 

  3. Tafuri A, Alferink J, Moller P, et al. T cell awareness of paternal alloantigens during pregnancy. Science 1995;270:630–633.

    Article  PubMed  CAS  Google Scholar 

  4. Jiang SP, Vacchio MS. Multiple mechanisms of peripheral T cell tolerance to the fetal “allograft”. J Immunol 1998;160:3086–3090.

    PubMed  CAS  Google Scholar 

  5. Zhang LI, Martin DR, Fung-Leung WP, et al. Peripheral deletion of mature CD8+ antigen-specific T cells after in vivo exposure to male antigen. J Immunol 1992;148:3740–3745.

    PubMed  CAS  Google Scholar 

  6. Adams KM, Yan Z, Stevens AM, et al. The changing maternal “self” hypothesis: a mechanism for maternal tolerance of the fetus. Placenta 2007;28:378–382.

    Article  PubMed  CAS  Google Scholar 

  7. Holmes VA, Wallace JM, Gilmore WS, et al. Plasma levels of the immunomodulatory cytokine interleukin-10 during normal human pregnancy: a longitudinal study. Cytokine 2003;21:265–269.

    Article  PubMed  CAS  Google Scholar 

  8. Steinbrink K, Jonuleit H, Muller G, et al. Interleukin-10-treated human dendritic cells induce a melanoma-antigen-specific anergy in CD8(+) T cells resulting in a failure to lyse tumor cells. Blood 1999;93:1634–1642.

    PubMed  CAS  Google Scholar 

  9. Zhao DM, Thornton AM, DiPaolo RJ, et al. Activated CD4+CD25+ T cells selectively kill B lymphocytes. Blood 2006;107:3925–3932.

    Article  PubMed  CAS  Google Scholar 

  10. Kaaja RJ, Greer IA. Manifestations of chronic disease during pregnancy. JAMA 2005; 294:2751–2757.

    Article  PubMed  CAS  Google Scholar 

  11. Milne JA, Howie AD, Pack AI. Dyspnoea during normal pregnancy. Br J Obstet Gynaecol 1978;85:260–263.

    Article  PubMed  CAS  Google Scholar 

  12. Contreras G, Gutierrez M, Beroiza T, et al. Ventilatory drive and respiratory muscle function in pregnancy. Am Rev Respir Dis 1991;144:837–841.

    Article  PubMed  CAS  Google Scholar 

  13. Boggess KA, Easterling TR, Raghu G. Management and outcome of pregnant women with interstitial and restrictive lung disease. Am J Obstet Gynecol 1995;173:1007–1014.

    Article  PubMed  CAS  Google Scholar 

  14. Alaily AB, Carrol KB. Pulmonary ventilation in pregnancy. Br J Obstet Gynaecol 1978;85:518–524.

    Article  PubMed  CAS  Google Scholar 

  15. Fishburne JI. Physiology and disease of the respiratory system in pregnancy. A review. J Reprod Med 1979;22:177–189.

    PubMed  CAS  Google Scholar 

  16. Milne JA, Mills RJ, Coutts JR, et al. The effect of human pregnancy on the pulmonary transfer factor for carbon monoxide as measured by the single-breath method. Clin Sci Mol Med 1977;53:271–276.

    PubMed  CAS  Google Scholar 

  17. Artal R, Wiswell R, Romem Y, et al. Pulmonary responses to exercise in pregnancy. Am J Obstet Gynecol 1986;154:378–383.

    PubMed  CAS  Google Scholar 

  18. Steen VD. Pregnancy in women with systemic sclerosis. Obstet Gynecol 1999;94:15–20.

    Article  PubMed  CAS  Google Scholar 

  19. Lambe M, Bjornadal L, Neregard P, et al. Childbearing and the risk of scleroderma: a population-based study in Sweden. Am J Epidemiol 2004;159:162–166.

    Article  PubMed  Google Scholar 

  20. Steen VD, Conte C, Day N, et al. Pregnancy in women with systemic sclerosis. Arthritis Rheum 1989;32:151–157.

    Article  PubMed  CAS  Google Scholar 

  21. Chung L, Flyckt RL, Colon I, et al. Outcome of pregnancies complicated by systemic sclerosis and mixed connective tissue disease. Lupus 2006;15:595–599.

    Article  PubMed  CAS  Google Scholar 

  22. Weiss BM, Zemp L, Seifert B, et al. Outcome of pulmonary vascular disease in pregnancy: a systematic overview from 1978 through 1996. J Am Coll Cardiol 1998; 31:1650–1657.

    Article  PubMed  CAS  Google Scholar 

  23. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 4-1999. A 38-year-old woman with increasing pulmonary hypertension after delivery. N Engl J Med 1999;340:455–464.

    Article  Google Scholar 

  24. Battenfeld R, Schuh W and Schobel C. Studies on reproductive toxicity of iloprost in rats, rabbits and monkeys. Toxicol 1995;letters 78:223–234.

    Google Scholar 

  25. Weiss BM, Hess OM. Pulmonary vascular disease and pregnancy: current controversies, management strategies, and perspectives. Eur Heart J 2000;21:104–115.

    Article  PubMed  CAS  Google Scholar 

  26. Cervera R, Font J, Carmona F, et al. Pregnancy outcome in systemic lupus erythematosus: good news for the new millennium. Autoimmun Rev 2002;1:354–359.

    Article  PubMed  Google Scholar 

  27. Petri M, Howard D, Repke J, et al. The Hopkins Lupus Pregnancy Center: 1987–1991 update. Am J Reprod Immunol 1992;28:188–191.

    PubMed  CAS  Google Scholar 

  28. Lockshin MD, Reinitz E, Druzin ML, et al. Lupus pregnancy. Case-control prospective study demonstrating absence of lupus exacerbation during or after pregnancy. Am J Med 1984;77:893–898.

    Article  PubMed  CAS  Google Scholar 

  29. Wong KL, Chan FY, Lee CP. Outcome of pregnancy in patients with systemic lupus erythematosus. A prospective study. Arch Intern Med 1991;151:269–273.

    Article  PubMed  CAS  Google Scholar 

  30. Khamashta MA, Ruiz-Irastorza G, Hughes GR. Systemic lupus erythematosus flares during pregnancy. Rheum Dis Clin North Am 1997;23:15–30.

    Article  PubMed  CAS  Google Scholar 

  31. Leikin JB, Arof HM, Pearlman LM. Acute lupus pneumonitis in the postpartum period: a case history and review of the literature. Obstet Gynecol 1986;68:29S–31S.

    PubMed  CAS  Google Scholar 

  32. Comer M, D'Cruz D, Thompson I, et al. Pneumonitis in a lupus twin pregnancy: a case report. Lupus 1996;5:146–148.

    Article  PubMed  CAS  Google Scholar 

  33. Gaither K, Halstead K, Mason TC. Pulmonary alveolar hemorrhage in a pregnancy complicated by systemic lupus erythematosus. J Natl Med Assoc 2005;97:831–833.

    PubMed  Google Scholar 

  34. Chang MY, Fang JT, Chen YC, et al. Diffuse alveolar hemorrhage in systemic lupus erythematosus: a single center retrospective study in Taiwan. Ren Fail 2002;24:791–802.

    Article  PubMed  Google Scholar 

  35. Loh FH, Arulkumaran S, Montan S, et al. Maternal mortality: evolving trends. Asia Oceania J Obstet Gynaecol 1994;20:301–304.

    Article  PubMed  CAS  Google Scholar 

  36. McMillan E, Martin WL, Waugh J, et al. Management of pregnancy in women with pulmonary hypertension secondary to SLE and anti-phospholipid syndrome. Lupus 2002;11:392–398.

    Article  PubMed  CAS  Google Scholar 

  37. Elliot CA, Stewart P, Webster VJ, et al. The use of iloprost in early pregnancy in patients with pulmonary arterial hypertension. Eur Respir J 2005;26:168–173.

    Article  PubMed  CAS  Google Scholar 

  38. Bendayan D, Hod M, Oron G, et al. Pregnancy outcome in patients with pulmonary arterial hypertension receiving prostacyclin therapy. Obstet Gynecol 2005;106:1206–1210.

    Article  PubMed  Google Scholar 

  39. Bologna C, Jorgensen C, Anaya JM, et al. Association of systemic lupus erythematosus and choriocarcinoma: a role of hormonal immunomodulation? Clin Exp Rheumatol 1994;12:59–61.

    PubMed  CAS  Google Scholar 

  40. Lockwood CJ, Romero R, Feinberg RF, Clyne LP, Coster B, Hobbins JC. The prevalence and biologic significance of lupus anticoagulant and anticardiolipin antibodies in a general obstetric population. Am J Obstet Gynecol 1989;161:369–373.

    PubMed  CAS  Google Scholar 

  41. Lynch A, Marlar R, Murphy J, et al. Antiphospholipid antibodies in predicting adverse pregnancy outcome. Ann Intern Med 1994;120:470–475.

    PubMed  CAS  Google Scholar 

  42. Pattison NS, Chamley LW, McKay EJ, et al. Antiphospholipid antibodies in pregnancy: prevalence and clinical associations. Br J Obstet Gynaecol 1993;100:909–913.

    Article  PubMed  CAS  Google Scholar 

  43. Yasuda M, Takakuwa K, Tokunaga A, Tanaka K. Prospective studies of the association between anticardiolipin antibody and outcome of pregnancy. Obstet Gynecol 1995;86:555–559.

    PubMed  CAS  Google Scholar 

  44. Branch DW, Silver RM, Blackwell JL, Reading JC, Scott JR. Outcome of treated pregnancies in women with antiphospholipid syndrome: an update of the Utah experience. Obstet Gynecol 1992;80:614–620.

    PubMed  CAS  Google Scholar 

  45. Rai RS, Clifford K, Cohen H, Regan L. High prospective fetal loss rate in untreated pregnancies of women with recurrent miscarriage and antiphospholipid antibodies. Hum Reprod 1995;10:3301–3304.

    PubMed  CAS  Google Scholar 

  46. Cowchock FS, Reece EA, Balaban D, Branch DW, Plouffe L. Repeated fetal losses associated with antiphospholipid antibodies: a collaborative randomized trial comparing prednisone to low-dose heparin treatment. Am J Obstet Gynecol 1992;166:1318–1327.

    PubMed  CAS  Google Scholar 

  47. Out HJ, Bruinse HW, Godlieve CML, et al. A prospective, controlled multicenter study on the obstetric risks of pregnant women with antiphospholipid antibodies. Am J Obstet Gynecol 1992;167:26–32.

    PubMed  CAS  Google Scholar 

  48. Goldstein SR. Embryonic death in early pregnancy: a new look at the first trimester. Obstet Gynecol 1994;84:294–297.

    PubMed  CAS  Google Scholar 

  49. Oshiro BT, Silver RM, Scott JR, Yu H, Branch DW. Antiphospholipid antibodies and fetal death. Obstet Gynecol 1996;87:489–493.

    Article  PubMed  CAS  Google Scholar 

  50. Rai RS, Regan L, Clifford K, et al. Antiphospholipid antibodies and beta2-glycoprotein-I in 500 women with recurrent miscarriage: results of a comprehensive screening approach. Hum Reprod 1995;10:2001–2005.

    PubMed  CAS  Google Scholar 

  51. Yetman DL, Kutteh WH. Antiphospholipid antibody panels and recurrent pregnancy loss: prevalence of anticardiolipin antibodies compared with other antiphospholipid antibodies. Fertil Steril 1996;66:540–546.

    PubMed  CAS  Google Scholar 

  52. Petri M, Golbus M, Anderson R, Whiting-O’Keefe Q, Corash L, Hellmann D. Antinuclear antibody, lupus anticoagulant, and anticardiolipin antibody in women with idiopathic habitual abortion. Arthritis Rheum 1987;30:601–606.

    Article  PubMed  CAS  Google Scholar 

  53. Barbui T, Cortelazzo S, Galli, et al. Antiphospholipid antibodies in early repeated abortions: a case-controlled study. Fertil Steril 1988;50:589–592.

    PubMed  CAS  Google Scholar 

  54. Parazzini F, Acaia B, Faden D, Lovotti M, Marelli G, Cortelazzo S. Antiphospholipid antibodies and recurrent abortion. Obstet Gynecol 1991;77:854–857.

    PubMed  CAS  Google Scholar 

  55. Parke AL, Wilson D, Maier D. The prevalence of antiphospholipid antibodies in women with recurrent spontaneous abortion, women with successful pregnancies, and women who have never been pregnant. Arthritis Rheum 1991;34:1231–1235.

    Article  PubMed  CAS  Google Scholar 

  56. Out HJ, Bruinse HW, Derksen RHWM. Antiphospholipid antibodies and pregnancy loss. Hum Reprod 1991;6:889–897.

    PubMed  CAS  Google Scholar 

  57. MacLean MA, Cumming GP, McCall F, Walker ID, Walker JJ. The prevalence of lupus anticoagulant and anticardiolipin antibodies in women with a history of first trimester miscarriages. Br J Obstet Gynaecol 1994;101:103–106.

    Article  PubMed  CAS  Google Scholar 

  58. Balasch J, Creus M, Fabregues F, et al. Antiphospholipid antibodies and human reproductive failure. Hum Reprod 1996;11:2310–2315.

    PubMed  CAS  Google Scholar 

  59. Lima F, Khamashta MA, Buchanan NMM, et al. A study of sixty pregnancies in patients with the antiphospholipid syndrome. Clin Exp Rheumatol 1996;14:131–136.

    PubMed  CAS  Google Scholar 

  60. Caruso A, DeCarolis S, Ferrazzani S, et al. Pregnancy outcome in relation to uterine artery flow velocimetry waveforms and clinical characteristics in women with antiphospholipid syndrome. Obstet Gynecol 1993;82:970–977.

    PubMed  CAS  Google Scholar 

  61. Kutteh WH. Antiphospholipid antibody associated recurrent pregnancy loss: treatment with heparin and low-dose aspirin is superior to low dose aspirin alone. Am J Obstet Gynecol 1996;174:1584–1589.

    Article  PubMed  CAS  Google Scholar 

  62. Sletnes KE, Wislof F, Moe N, Dale PO. Antiphospholipid antibodies in preeclamptic women: relation to growth retardation and neonatal outcome. Acta Obstet Gynecol Scand 1992;71:112–117.

    Article  PubMed  CAS  Google Scholar 

  63. Moodley J, Bhoola V, Duursma J, Pudfin D, Byrne S, Kenoyer DG. The association of antiphospholipid antibodies with severe early onset preeclampsia. S Afr Med J 1995;85:105–107.

    PubMed  CAS  Google Scholar 

  64. Branch DW, Andres R, Digre KB, Rote NS, Scott JR. The association of antiphospholipid antibodies with severe preeclampsia. Obstet Gynecol 1989;73:541–515.

    PubMed  CAS  Google Scholar 

  65. Milliez J, Lelong F, Bayani N, et al. The prevalence of autoantibodies during third trimester pregnancy complicated by hypertension or idiopathic fetal growth retardation. Am J Obstet Gynecol 1991;165:51–56.

    PubMed  CAS  Google Scholar 

  66. Badacarro MH, Vessey M. Recurrence of venous thromboembolic disease and the use of oral contraceptives. Br Med J 1974;1(5901):215–217.

    Article  Google Scholar 

  67. Rosene-Montella K. Hypercoagulable states in pregnancy. Curr Obstet Med 1993;2:141–161.

    Google Scholar 

  68. Schafer AI. The hypercoagulable states. Ann Intern Med 1985;102:814–828.

    PubMed  CAS  Google Scholar 

  69. Hughes GRV. The antiphospholipid syndrome: ten years on. Lancet 1993:342:341–344.

    Article  PubMed  CAS  Google Scholar 

  70. Toubi E, Khamashta MA, Panarra A, Hughes GR. Association of antiphospholipid antibodies with central nervous system disease in systemic lupus erythematosus. Am J Med 1995:99:397–401.

    Article  PubMed  CAS  Google Scholar 

  71. Wahl DG, Guillemin F, de Maistre E, et al. Meta-analysis of the risk of venous thrombosis in individuals with antiphospholipid antibodies without underlying autoimmune disease or previous thrombosis. Lupus 1998;7:15–22.

    Article  PubMed  CAS  Google Scholar 

  72. Sammaritano LR. Therapy insight: guidelines for selection of contraception in women with rheumatic diseases. Nat Clin Pract Rheumatol 2007;3(5):273–281.

    Article  PubMed  Google Scholar 

  73. Rai R, Cohen H, Dave M, Regan L. Randomised controlled trial of aspirin and aspirin plus heparin in pregnant women with recurrent miscarriage associated with phospholipid antibodies (or antiphospholipid antibodies). BMJ 1997;314:253–257.

    Article  PubMed  CAS  Google Scholar 

  74. Kutteh WH. Antiphospholipid antibody associated recurrent pregnancy loss: treatment with heparin and low-dose aspirin is superior to low dose aspirin alone. Am J Obstet Gynecol 1996;174:1584–1589.

    Article  PubMed  CAS  Google Scholar 

  75. Petri M, Qazi U. Management of antiphospholipid syndrome in pregnancy. Rheum Dis Clin N Am 2006;32:591–607.

    Article  Google Scholar 

  76. Kochenour NK, Branch DW, Rote NS, Scott JR. A new postpartum syndrome associated with antiphospholipid antibodies. Obstet Gynecol 1987;69:460–468.

    PubMed  CAS  Google Scholar 

  77. Silver RM, Draper ML, Scott JR, Lyon JL, Reading J, Branch DW. Clinical consequences of antiphospholipid antibodies: a historic cohort study. Obstet Gynecol 1994;83:372–377.

    PubMed  CAS  Google Scholar 

  78. Khamashta MA, Cuadrado MJ, Mujic F, Taub NA, Hunt BJ, Hughes GRV. The management of thrombosis in the antiphospholipid-antibody syndrome. N Engl J Med 1995;332:993–997.

    Article  PubMed  CAS  Google Scholar 

  79. Ruiz-Irastorza G, Khamashta MA. Systematic lupus erythematosus and antiphospholipid syndrome during pregnancy. Z Rheumatol 2006;65:192–194, 196–199.

    Article  PubMed  CAS  Google Scholar 

  80. Ostensen M, Ostensen H. Ankylosing spondylitis – the female aspect. J Rheumatol 1998;25:120–124.

    PubMed  CAS  Google Scholar 

  81. Barrett JH, Brennan P, Fiddler M, et al. Breast-feeding and postpartum relapse in women with rheumatoid and inflammatory arthritis. Arthritis Rheum 2000;43:1010–1015.

    Article  PubMed  CAS  Google Scholar 

  82. Yan Z, Lambert NC, Ostensen M, et al. Prospective study of fetal DNA in serum and disease activity during pregnancy in women with inflammatory arthritis. Arthritis Rheum 2006;54:2069–2073.

    Article  PubMed  CAS  Google Scholar 

  83. Picone O, Alby C, Frydman R, et al. Sjogren syndrome in Obstetric and Gynecology: literature review. J Gynecol Obstet Biol Reprod (Paris) 2006;35:169–175.

    CAS  Google Scholar 

  84. Haga HJ, Gjesdal CG, Irgens LM, et al. Reproduction and gynaecological manifestations in women with primary Sjogren's syndrome: a case-control study. Scand J Rheumatol 2005;34:45–48.

    Article  PubMed  CAS  Google Scholar 

  85. Costedoat-Chalumeau N, Amoura Z, Le Thi Hong D, et al. Neonatal lupus syndrome: review of the literature. Rev Med Interne 2003;24:659–671.

    Article  PubMed  CAS  Google Scholar 

  86. Gutierrez G, Dagnino R, Mintz G. Polymyositis/dermatomyositis and pregnancy. Arthritis Rheum 1984;27:291–294.

    Article  PubMed  CAS  Google Scholar 

  87. Silva CA, Sultan SM, Isenberg DA. Pregnancy outcome in adult-onset idiopathic inflammatory myopathy. Rheumatology (Oxford) 2003;42:1168–1172.

    Article  CAS  Google Scholar 

  88. Vancsa A, Ponyi A, Constantin T, et al. Pregnancy outcome in idiopathic inflammatory myopathy. Rheumatol Int 2007;27:435–439.

    Google Scholar 

  89. Williams L, Chang PY, Park E, et al. Successful treatment of dermatomyositis during pregnancy with intravenous immunoglobulin monotherapy. Obstet Gynecol 2007;109:561–563.

    Article  PubMed  CAS  Google Scholar 

  90. Mosca M, Strigini F, Carmignani A, et al. Pregnant patient with dermatomyositis successfully treated with intravenous immunoglobulin therapy. Arthritis Rheum 2005; 53:119–121.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Clinique des Maladies Respiratoires, Hôpital Albert Calmette, Boulevard du Pr. Jules Leclercq, Lille Cedex, France

    Stéphanie Pouwels-Fry, Isabelle Tillie-Leblond & Benoît Wallaert

Authors
  1. Stéphanie Pouwels-Fry
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Isabelle Tillie-Leblond
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Benoît Wallaert
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

    Rights and permissions

    Reprints and permissions

    Copyright information

    © 2009 Humana Press, a part of Springer Science+Business Media, LLC

    About this chapter

    Cite this chapter

    Pouwels-Fry, S., Tillie-Leblond, I., Wallaert, B. (2009). Pulmonary Complications of Collagen Vascular Disease in Pregnancy. In: Rosene-Montella, K., Bourjeily, G. (eds) Pulmonary Problems in Pregnancy. Respiratory Medicine. Humana Press. https://doi.org/10.1007/978-1-59745-445-2_17

    Download citation

    • DOI: https://doi.org/10.1007/978-1-59745-445-2_17

    • Published:

    • Publisher Name: Humana Press

    • Print ISBN: 978-1-934115-12-1

    • Online ISBN: 978-1-59745-445-2

    • eBook Packages: MedicineMedicine (R0)

    Publish with us

    Policies and ethics

    Search

    Navigation