No Sirolimus? No Problem: Alternative Management of Lymphangioleiomyomatosis During Pregnancy

Islam, Tasnim; Birdwell, Angela; Winsett, Robert; Caceres, Diego Maselli; Vélez, Maria P.; Habib, Sheila

doi:10.1016/j.chest.2019.08.1929

Cited by 1 publication

(2 citation statements)

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“…The remaining 25 (81%) of studies were case reports that included one patient each. Of the 31 studies included, 9 (29%) were published in the United States 14,15,[17][18][19][20][21][22][23] , 7 (23%) in the United Kingdom 9,18,24-28 , 6 (19%) in Japan 16,[29][30][31][32][33] , and one from each of the following countries: Germany 34 , Ireland 35 , Iran 36 , Scotland 37 , Australia 38 , India 39 , Israel 40 , Italy 41 , and Canada 4 .…”

Section: Resultsmentioning

confidence: 99%

“…The remaining 25 (81%) of studies were case reports that included one patient each. Of the 31 studies included, 9 (29%) were published in the United States, 14,15,[17][18][19][20][21][22][23] 7 (23%) in the United Kingdom, 9,18,24-28 6 (19%) in Japan, 16,[29][30][31][32][33] and 1 from each of the following countries: Germany, 34 Ireland, 35 Iran, 36 Scotland, 37 Australia, 38 India, 39 Israel, 40 Italy, 41 and Canada. 4 Regarding risk of bias among the 7 cohort studies, 2 studies (33%) received <5 points, while 5 studies (67%) received !5 points, indicating the majority of cohort studies had a low risk of bias.…”

Section: Resultsmentioning

confidence: 99%

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Systematic Review of Lymphangioleiomyomatosis Outcomes in Pregnancy and a Proposed Management Guideline

et al. 2023

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Background: Lymphangioleiomyomatosis (LAM) is a rare, multisystem disease that primarily affects women of reproductive age. Disease progression has been linked to estrogen exposure, and as such many patients are advised to avoid pregnancy. Data are limited regarding the interaction between LAM and pregnancy, and as such we performed a systematic review to summarize available literature reporting outcomes of pregnancies complicated by maternal LAM. Study Design: This was a systematic review including randomized controlled trials, observational studies, systematic reviews, case reports, clinical practice guidelines, and quality improvement studies with full text manuscripts or abstracts in the English language with primary data on pregnant or postpartum patients with LAM. The primary outcome was maternal outcomes during pregnancy as well as pregnancy outcomes. Secondary outcomes were neonatal outcomes and long-term maternal outcomes. This search occurred in June 2020 and included MEDLINE, Scopus, clinicaltrials.gov, Embase, and Cochrane Central. Risk of bias was ascertained using the Newcastle-Ottawa Scale. Our systematic review was registered with PROSPERO as protocol number CRD 42020191402. Results: 175 publications were identified in our initial search; ultimately 31 studies were included. Six (19%) studies were retrospective cohort studies and twenty-five (81%) studies were case reports. Patients diagnosed during pregnancy had worse pregnancy outcomes compared to those diagnosed with LAM prior to pregnancy. Multiple studies reported a significant risk of pneumothoraces during pregnancy. Other significant risks included preterm delivery, chythoraces, and pulmonary function deterioration. A proposed strategy for preconception counseling and antenatal management is provided. Conclusion: Patients diagnosed with LAM during pregnancy generally experience worse outcomes including recurrent pneumothoraces and preterm delivery as compared to patients with a LAM diagnosis prior to pregnancy. Further investigation of the interaction between LAM and pregnancy is warranted to guide patient care and counseling.

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