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Sarcoidosis in Pregnancy and Postpartum Period

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Sarcoidosis is a multisystemic disease of unknown etiology, characterized by granulomatous inflammation. It typically presents between the ages of 20 to 40 years old. An estimated 0.02% to 0.05% of pregnancies occur in patients with sarcoidosis. Although fetal loss has been reported in mothers with sarcoidosis, limited studies do not suggest an increase risk of fetal or neonatal complications. Several reports suggest an improvement of sarcoidosis during pregnancy. Sarcoidosis, a Th1-mediated disease, seems to follow the same course as rheumatoid arthritis during pregnancy and postpartum. Estrogen levels increase during pregnancy, resulting in a decreased Th1-mediated immune response, which can improve active sarcoidosis. Free plasma cortisol concentrations increase in pregnancy, with plasma levels 2- to 3-fold higher than those of non-pregnant controls, suggesting greater tissue exposure to glucocorticoids during pregnancy. This may result in decreased granulomatous inflammation with improvement in symptoms and clinical findings. During the postpartum period, when free cortisol levels return to the prior non-pregnant levels, reactivation of sarcoidosis can occur. The majority of patients with sarcoidosis will either have a stable disease or will experience improvement in their symptoms. A small group of pregnant mother with active sarcoidosis, however, may develop more progressive disease during pregnancy. The manifestations, course of disease, and treatment options during pregnancy and postpartum period are discussed.

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Keywords: Sarcoidosis; Th1 cells; corticosteroids; lung function; pregnancy

Document Type: Research Article

Affiliations: Department of Pulmonary and Critical Care Medicine, Thomas Jefferson University, 834 Walnut Street, Suite 650, Philadelphia, PA 19107, USA.

Publication date: February 1, 2007

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  • Current Respiratory Medicine Reviews publishes frontier reviews on all the latest advances on respiratory diseases and its related areas e.g. pharmacology, pathogenesis, clinical care, and therapy. The journal's aim is to publish the highest quality review articles dedicated to clinical research in the field. The journal is essential reading for all researchers and clinicians in respiratory medicine.
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