Author(s)
Niloufar Saeedi, MD
Diana C. Lopez-Fay, MD
Samuel L. Collins, PHD
Kevin M. Motz, MD
Ronit E. Malka, MD
Yee Chan-Li, BS
Lee M. Akst, MD
Simon R. Best, MD
Jessica L. Bienstock, MD MPH2
Alexander T. Hillel, MD
Affiliation(s)
John Hopkins University School of Medicine
Abstract:
Objective: To evaluate safety and clinical course in pregnant idiopathic subglottic stenosis (iSGS) patients and to identify variables associated with operative dilation requirement during pregnancy.
Background: Pregnancy in patients with iSGS presents management challenges that may impact maternal and fetal health. Clinical studies and shared experiences are limited.
Methods: A retrospective chart review was conducted evaluating pregnant iSGS patients and an age matched never-pregnant iSGS control group. Pregnant patients were subcategorized based on whether they required surgery during pregnancy. The analyzed variables included demographics, inter-dilation intervals, time to first recurrence, intraoperative stenosis percent, and fetal and maternal safety.
Results: Thirty-three patients were included, twenty-three in the pregnancy group, and 10 in the control group. Thirteen patients required operative intervention during pregnancy. The mean age at iSGS diagnosis was 31.1 years. All pregnancies resulted in live births. no surgical or anesthesia-related complications were reported. Anti-nuclear antibody (ANA) positivity was more frequent in the surgical-intervention group compared to the non-intervention group (5/10 vs. 0, p<0.05). The overall inter-dilation interval was longer in the pregnancy group compared to the control group (median: 70.9 vs. 39.6 weeks, p<0.05) Average stenosis percentages in surgical dilations during and prior to pregnancy were comparable (60.4 ± 21.6 vs. 55.2 ± 27.8).
Conclusion: Surgical management of iSGS patients is safe during pregnancy. Greater than 50% patients experienced exacerbation during pregnancy that required operative intervention. The only notable patient-specific factor associated with dilation during pregnancy was ANA positivity. There were no pregnancy-specific factors associated with the need for intervention.