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Am J Perinatol 2024; 41(S 01): e1508-e1520
DOI: 10.1055/a-2051-8395
Original Article

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

Macie L. Champion 
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health at the University of Alabama at Birmingham, Birmingham, Alabama
,
Julia G. Maier
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health at the University of Alabama at Birmingham, Birmingham, Alabama
,
Elisa T. Bushman
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health at the University of Alabama at Birmingham, Birmingham, Alabama
,
Joseph B. Barney
2   Department of Pulmonary, Allergy, and Critical Care Medicine, The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
,
Brian M. Casey
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health at the University of Alabama at Birmingham, Birmingham, Alabama
,
Rachel G. Sinkey
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health at the University of Alabama at Birmingham, Birmingham, Alabama
› Author Affiliations Funding None.
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Abstract

Objective 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 July 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 A total of 175 publications were identified in our initial search; ultimately 31 studies were included. Six (19%) studies were retrospective cohort studies and 25 (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, chylothoraces, 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. Given that there are limited studies available, and that the majority are low-quality evidence and subject to bias, further investigation of the interaction between LAM and pregnancy is warranted to guide patient care and counseling.

Key Points

  • Data are limited on the effects of lymphangioleiomyomatosis on pregnancy outcomes.

  • We performed a systematic review to summarize pregnancy outcomes complicated by LAM.

  • Patients diagnosed with LAM during pregnancy experience worse outcomes.

Keywords

pregnancy - maternal–fetal - lymphangioleiomyomatosis

Supplementary Material



Publication History

Received: 13 July 2022

Accepted: 24 February 2023

Accepted Manuscript online:
10 March 2023

Article published online:
18 April 2023

© 2023. Thieme. All rights reserved.

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