Sarcoidosis in Pregnancy and Postpartum Period

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.