Sarcoidosis in pregnancy

Abstract

Key content: Sarcoidosis is an uncommon multi‐system disorder characterised by the presence of non‐caseating granulomas. It has a peak incidence between the ages of 20–40 years old. The pathogenesis of sarcoidosis is uncertain; however, it is known to be associated with an exaggerated T helper 1 (TH1) immune response leading to systemic inflammation and granuloma formation. Suppression in TH1 responses in pregnancy leads to disease remission in the majority of pregnancies. Nevertheless, the potential for decompensation in a subgroup remains, and consideration should be given to the pre‐pregnancy state. Sarcoidosis is associated with increased risk of maternal‐fetal morbidity, including growth restriction and pre‐eclampsia. Clinical management should focus on medication optimisation and mitigation of this increased risk. Learning objectives: To understand the clinical features, pathogenesis and diagnosis of sarcoidosis. To understand the effect of pregnancy on sarcoidosis. To understand the effect of sarcoidosis on pregnancy and the related obstetric outcomes. To understand the management of sarcoidosis in pregnancy. Ethical issues: There can be difficulties in appropriate management of medical disorders, such as sarcoidosis, with a limited obstetric evidence base. There are challenges in decision‐making regarding continuation of pregnancy in severe disease with an uncertain evidence base.