Pregnancy is one of the stages in a woman's life that requires careful medical attention, particularly if she has a rare autoimmune condition that may affect her health during this period. One such condition is Cogan's syndrome, which affects the eyes and inner ears and may, in some cases, involve the blood vessels and heart.This raises important questions about how the syndrome may affect pregnancy, the potential risks to the mother and fetus, and whether its symptoms can be controlled without compromising the safety of the pregnancy.Although Cogan's syndrome is rare and research on its effects during pregnancy is limited, early diagnosis, appropriate treatment selection, and regular follow-up with specialist doctors are essential steps in reducing potential complications.What are the main risks of Cogan's syndrome during pregnancy? How can the condition be managed and its complications prevented? Which treatments may be used safely during this stage?In this article, Dalili Medical explores the essential medical information and guidance that every woman living with Cogan's syndrome should know.

What Is Cogan Syndrome?

Cogan syndrome is a rare autoimmune disorder that causes inflammation of the eyes and inner ear. In some cases, it may also be associated with inflammation of the blood vessels, including large blood vessels. The importance of this condition during pregnancy lies in the need to monitor the mother's health, reduce potential complications, and select appropriate treatments that take fetal safety into account.

Does Cogan Syndrome During Pregnancy Pose a Risk to the Mother and Fetus?

Cogan syndrome may pose risks to the mother's health, particularly if the disease causes severe inflammation of the eyes or inner ear or affects the blood vessels and heart. As for the direct effects of the syndrome on the fetus, the available scientific evidence remains limited. Therefore, regular medical follow-up is essential to assess potential risks and protect the health of both the mother and the fetus.

Can a Woman With Cogan Syndrome Have a Normal Pregnancy?

Yes, a woman with Cogan syndrome may be able to conceive and have a successful pregnancy, especially if the disease is stable and her medications are suitable for use during pregnancy. However, pregnancy planning in consultation with the relevant specialists is recommended to assess disease activity, review current medications, and establish an appropriate monitoring plan throughout pregnancy.

Does Cogan Syndrome Affect Fetal Growth?

There is insufficient scientific evidence to confirm that Cogan syndrome directly affects fetal growth. However, severe maternal health complications or the use of certain medications that are unsuitable during pregnancy may affect pregnancy outcomes and fetal development. Therefore, monitoring fetal growth and performing the necessary examinations are recommended according to the obstetrician's assessment.

Does Cogan Syndrome Cause Miscarriage or Premature Birth?

There is insufficient scientific evidence to determine whether Cogan syndrome itself increases the risk of miscarriage or premature birth, or to estimate the extent of this risk accurately. Pregnancy outcomes may be influenced by several factors, including disease activity, the presence of cardiac or vascular complications, and the medications used during pregnancy. Specialized medical follow-up and appropriate treatment selection are therefore important steps in reducing potential risks.

Does Cogan Syndrome Affect the Mode of Delivery?

Having Cogan syndrome does not necessarily mean that a cesarean section is required. The mode of delivery depends on the health of the mother and fetus, the stability of the disease, and the presence of any cardiac or vascular complications. The doctor determines the most appropriate delivery method based on a comprehensive medical assessment to ensure the greatest possible safety for both the mother and the fetus.

Can a Mother With Cogan Syndrome Breastfeed After Delivery?

A mother with Cogan syndrome may be able to breastfeed after delivery, depending on the treatment she receives and whether her medications are compatible with breastfeeding. Therefore, medications should be reviewed with the doctor before or after delivery to identify suitable treatment options that help control the disease while protecting the infant's health.

When Does Cogan Syndrome During Pregnancy Become a Medical Emergency?

Certain symptoms require urgent medical attention, particularly severe or sudden chest pain, severe shortness of breath, fainting, or a sudden, severe headache accompanied by visual disturbances or neurological symptoms. Sudden hearing loss or rapidly worsening vision also requires urgent medical evaluation because these symptoms may indicate complications that need prompt treatment.

Can Cogan Syndrome Flare Up Again After Delivery?

Yes, symptoms of Cogan syndrome may persist after delivery, or the disease may become active again. However, the available scientific evidence is insufficient to determine how frequently this occurs. Continued medical follow-up after delivery is therefore recommended, along with monitoring for changes in hearing, vision, or general health. Patients should follow their treatment plan and avoid stopping medications or changing doses without consulting their specialist.

Causes of Cogan Syndrome Associated With Pregnancy

Cogan syndrome is a rare inflammatory disorder believed to be associated with immune system dysfunction. It primarily affects the eyes and inner ear and may extend to the blood vessels and other organs in some cases. Although the exact causes of the condition have not yet been definitively established, the immune and hormonal changes that occur during pregnancy raise questions about their possible relationship to the onset or activity of the disease. However, there is insufficient scientific evidence to prove that pregnancy itself causes Cogan syndrome or necessarily worsens the condition.

1. Immune System Dysfunction

Cogan syndrome is believed to be associated with an abnormal immune response in which the immune system mistakenly attacks healthy tissues, particularly those of the eyes and inner ear. Some patients may also develop inflammation of the blood vessels.

During pregnancy, natural changes occur in the immune system to support the continuation of pregnancy and help the body adapt to the presence of the fetus. However, these changes have not been proven to directly cause Cogan syndrome or increase disease activity in all affected women.

2. Previous Infections

Some medical reports suggest that symptoms of Cogan syndrome may develop after an infection, particularly an upper respiratory tract infection. It is possible that, in some individuals, an infection triggers an abnormal immune response that contributes to the development of symptoms.

However, no specific microorganism has been established as the definitive cause of the syndrome, and no conclusive causal relationship has been demonstrated between a particular infection and the onset of the disease. Therefore, an infection cannot be considered a direct and confirmed cause of Cogan syndrome during pregnancy.

3. Pregnancy-Related Immune Changes

During pregnancy, women experience hormonal and immune changes that may influence the activity of certain autoimmune diseases. The severity of some of these conditions may also change after delivery. However, the effects of these changes on Cogan syndrome specifically remain unclear because the disease is rare and studies involving pregnant women with the condition are limited.

Medical reports have documented cases of women with Cogan syndrome during pregnancy. Nevertheless, these reports are insufficient to establish that pregnancy causes the condition or inevitably leads to worsening symptoms.

4. Do Genetic Factors Play a Role in Cogan Syndrome?

Cogan syndrome is not generally classified as an inherited disorder that is directly passed from parents to children. No confirmed genetic factor has been identified to explain the development of the condition. There is also insufficient evidence that a family history of the disease or pregnancy alone increases the likelihood of developing it.

5. Can the Cause of Cogan Syndrome in Pregnant Women Be Identified?

In most cases, it is not possible to identify a single confirmed cause of Cogan syndrome. Diagnosis relies on evaluating symptoms, performing specialized examinations, and ruling out other conditions that may cause similar symptoms.

The main symptoms that require attention include:

• Redness, eye pain, or severe sensitivity to light.

• Blurred vision or reduced visual acuity.

• Hearing loss or ringing in the ears (tinnitus).

• Dizziness and balance problems.

• Fever or joint pain in some cases.

If these symptoms occur during pregnancy, it is important to seek prompt medical evaluation, particularly if sudden hearing loss or worsening vision develops. Early diagnosis may help reduce the risk of permanent complications.

Care should ideally be coordinated among an ophthalmologist, an ear, nose, and throat (ENT) specialist, and an obstetrician to ensure that an appropriate treatment plan is selected during pregnancy.

Symptoms of Cogan Syndrome Associated With Pregnancy

Cogan syndrome is a rare inflammatory disorder that primarily affects the eyes and inner ear and may cause problems with vision, hearing, and balance. Although the syndrome is not commonly associated with pregnancy, the development of its symptoms in a pregnant woman requires careful medical evaluation because of the potential for complications affecting maternal health and the need to select appropriate treatment during this period.

The presence of eye or ear symptoms during pregnancy does not necessarily indicate Cogan syndrome, as these symptoms may resemble those of other medical conditions. Therefore, diagnosis depends on a medical examination and the exclusion of other possible causes.

What Are the Main Symptoms of Cogan Syndrome During Pregnancy?

Symptoms vary from one woman to another depending on the organs affected and the severity of inflammation. They may develop gradually or appear over a short period.

1. Eye Symptoms

Eye symptoms are among the main features of Cogan syndrome and may include:

• Redness and pain in the eyes due to inflammation.

• Severe sensitivity to light (photophobia).

• Blurred vision or reduced visual acuity.

• Excessive tearing or a sensation of having a foreign body in the eye.

Severe or persistent inflammation may lead to complications that affect vision if it is not treated appropriately. Therefore, these symptoms should not be ignored during pregnancy.

2. Inner Ear and Hearing Symptoms

Cogan syndrome may affect the inner ear, causing symptoms that interfere with hearing and balance. These may include:

• Vertigo or a sensation that the surroundings are spinning.

• Ringing in the ears (tinnitus).

• Hearing loss, which may develop rapidly in one or both ears.

• Loss of balance, sometimes accompanied by nausea or vomiting.

Sudden hearing loss is a symptom that requires urgent medical evaluation because prompt intervention may be important for preserving hearing.

3. General Symptoms Associated With the Syndrome

In addition to eye and ear symptoms, general symptoms may occur, including:

• Fatigue and a general feeling of exhaustion.

• Fever.

• Headache.

• Muscle and joint pain.

In some cases, Cogan syndrome may be associated with inflammation of the blood vessels, including the aorta. It may also affect the heart valves or heart function, requiring specialist evaluation when these complications are suspected.

Do All Symptoms of Cogan Syndrome Occur in Pregnant Women?

No. A patient does not necessarily experience all symptoms at the same time. The condition may begin with eye symptoms or disturbances in hearing and balance, followed by the development of other symptoms later. The severity of symptoms and the course of the disease also vary from one patient to another.

It is important to remember that some symptoms, such as dizziness, headache, and fatigue, may occur for various reasons during pregnancy. These symptoms alone are not sufficient to diagnose Cogan syndrome.

When Should Medical Help Be Sought?

Urgent medical evaluation is recommended if sudden hearing loss, rapidly worsening vision, or severe eye pain occurs. Sudden chest pain, severe shortness of breath, or fainting requires immediate emergency care. Follow-up should ideally be coordinated among an ophthalmologist, an ear, nose, and throat (ENT) specialist, and an obstetrician to ensure an accurate diagnosis and appropriate treatment during pregnancy.

Does Cogan Syndrome Affect Pregnancy or the Fetus?

Medical information about Cogan syndrome during pregnancy is limited because the disease is rare. Cases have been reported in which women completed their pregnancies successfully under appropriate medical supervision. Potential risks depend on disease activity, the extent of blood vessel and heart involvement, and the medications used to control inflammation.

A diagnosis of Cogan syndrome does not necessarily mean that pregnancy complications will occur. However, the condition requires careful monitoring to assess the health of both the mother and the fetus and to develop a safe treatment plan.

How Is Cogan Syndrome Diagnosed During Pregnancy?

There is no single test that confirms Cogan syndrome. Diagnosis relies on symptoms, clinical examination, and a combination of tests that help rule out other conditions with similar symptoms. These examinations include:

1. Eye examination: A slit-lamp examination is used to detect keratitis or other inflammatory changes in the eye.

2. Hearing and balance tests: Audiometry is used to assess sensorineural hearing loss. Additional tests may be performed to evaluate inner ear function and balance.

3. Blood tests: These may include the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), along with other tests to rule out infections and certain similar autoimmune diseases.

4. Cardiovascular examinations: These are performed when vascular inflammation or cardiovascular complications are suspected. The appropriate tests are selected according to the physician's assessment and pregnancy-related considerations.

5. Pregnancy monitoring: Regular prenatal examinations and ultrasound scans are used to monitor fetal growth according to the plan established by the obstetrician.

What Are the Risks of Cogan Syndrome During Pregnancy?

Cogan syndrome is a rare autoimmune inflammatory disease that primarily affects the eyes and inner ear. It may also involve large blood vessels, including the aorta. During pregnancy, potential risks depend on disease activity, the severity of inflammation, the extent of cardiovascular involvement, and the safety of the medications being used.

First: Potential Risks to the Mother

1. Worsening Vision

Persistent or worsening eye inflammation may cause pain, redness, sensitivity to light, and blurred vision. In severe cases that do not respond to treatment, permanent visual impairment may occur. Therefore, early evaluation and treatment of any changes in vision are extremely important.

2. Hearing Loss and Vertigo

The inner ear may be affected, leading to symptoms such as tinnitus, dizziness, balance disturbances, and sensorineural hearing loss. Hearing loss may become permanent in some cases, making prompt medical evaluation and treatment essential.

3. Vasculitis and Cardiovascular Complications

In some cases, inflammation may affect the aorta or the aortic valve, potentially leading to aortic valve insufficiency, aortic dilation, or aortic dissection. Although these complications are not inevitable, they can pose serious health risks and require specialist evaluation and close monitoring, particularly during pregnancy.

4. Disease Activity During Pregnancy

Symptoms may remain stable in some pregnant women, while inflammation may persist or worsen in others. Associated symptoms may include fever, joint pain, and muscle pain, depending on the extent of inflammation.

Second: Potential Risks to the Fetus

There is insufficient evidence to determine the specific fetal risks associated with Cogan syndrome accurately. However, several factors require attention:

- Premature birth or low birth weight: There is insufficient evidence to establish the extent to which these outcomes are specifically associated with Cogan syndrome. Pregnancy outcomes may be influenced by disease severity and associated complications.

- Effects of medications on the fetus: The safety of treatment varies depending on the medication and the stage of pregnancy. Some medications, such as methotrexate and cyclophosphamide, can harm the fetus and are generally avoided during pregnancy. Therefore, the treatment plan should be reviewed with a physician before conception or as soon as pregnancy is confirmed.

- Active disease and severe complications: Uncontrolled inflammation or serious cardiovascular complications may increase health risks for the mother and could indirectly affect pregnancy outcomes.

It is important to emphasize that studies of pregnancy in women with Cogan syndrome are extremely limited, although cases resulting in the birth of healthy infants have been reported. Nevertheless, the same outcome cannot be guaranteed in every case, as risks vary from one woman to another.

Third: How Can the Risks of Cogan Syndrome During Pregnancy Be Reduced?

Regular medical follow-up can help detect complications early and reduce potential risks. The most important measures include:

Follow-up with a specialized medical team: This should include an obstetrician, a rheumatologist or immunologist, an ophthalmologist, and an ear, nose, and throat (ENT) specialist. A cardiologist should also be involved when necessary.

Monitoring symptoms and performing appropriate tests: Hearing, vision, and blood pressure should be monitored. The heart and aorta should be evaluated according to symptoms and the level of risk.

Monitoring fetal growth: Routine prenatal examinations and ultrasound scans should be performed according to the schedule recommended by the treating physician.

Medication review: Ensure that all medications are appropriate for pregnancy. Do not suddenly stop corticosteroids or any prescribed medication without consulting your doctor, as this may lead to worsening of the disease.

When Should Urgent Medical Care Be Sought?

Seek urgent medical evaluation if you experience sudden hearing loss, rapidly worsening vision or hearing, severe chest pain, severe shortness of breath, or fainting. These symptoms may indicate complications that require prompt intervention.

Treatment of Cogan Syndrome Associated with Pregnancy

Treating Cogan syndrome during pregnancy requires a careful balance between controlling inflammation, protecting vision and hearing, and minimizing potential risks to both the mother and fetus. Therefore, the treatment plan should be developed collaboratively by a rheumatologist, an obstetrician, an ophthalmologist, and an ENT specialist, with a cardiologist involved if the blood vessels or heart valves are affected.

Because the disease is rare and pregnancy-specific research is limited, there is no single treatment protocol suitable for every patient. Treatment selection depends on the severity of inflammation, the organs involved, the stage of pregnancy, and the response to medication.

1. Corticosteroid Treatment

Corticosteroids, such as prednisolone, are used to control inflammation in Cogan syndrome. The physician determines the type of medication, dosage, and route of administration according to the severity of the condition while considering the potential effects of treatment during pregnancy.

• Prednisolone: May be used to control inflammation affecting the eyes, inner ear, or other parts of the body. The lowest effective dose is selected according to the physician's assessment.

• Intravenous methylprednisolone: May be administered in a hospital setting when inflammation is severe or hearing or vision is deteriorating rapidly.

• Corticosteroid eye drops: An ophthalmologist may prescribe these for certain types of eye inflammation after evaluating the eye and ruling out infection. These drops are not appropriate for every cause of eye redness or pain.

Although some corticosteroids can be used during pregnancy when necessary, medical supervision is essential. Depending on the dosage and duration of treatment, blood pressure and blood glucose may need to be monitored.

Important warning: Do not start corticosteroid treatment on your own, and do not suddenly stop taking it if you are already using it. Uncontrolled inflammation may cause permanent hearing or vision damage.

2. Immunosuppressive Medications and Other Treatments During Pregnancy

If corticosteroids are insufficient to control the disease, the physician may consider adding another medication to reduce inflammatory activity or minimize the need for high corticosteroid doses. Each option must be evaluated according to the available evidence and its safety during pregnancy.

Medication or Treatment	Considerations During Pregnancy
Azathioprine	Can be used during pregnancy when necessary, following an individualized medical assessment and appropriate monitoring.
Cyclosporine	May be considered in selected cases, with monitoring of blood pressure, kidney function, and drug levels when indicated.
Intravenous immunoglobulin (IVIG)	May be considered in selected cases that are difficult to control with other treatments. One published case described a woman with Cogan syndrome who gave birth to three healthy children while receiving IVIG. However, this observation alone is insufficient to establish its effectiveness or guarantee similar outcomes in all pregnant patients.
Certolizumab pegol	May be considered by a specialist team in certain treatment-resistant cases. Reports have described three pregnancies in two patients with Cogan syndrome, but evidence specific to this disease remains extremely limited.

Some of these options are compatible with pregnancy according to broader guidelines for immunomodulatory medications. However, their suitability for Cogan syndrome depends on the individual case. Their relative safety does not mean they are appropriate for every pregnant patient.

Medications That Should Be Avoided During Pregnancy

• Methotrexate: Contraindicated during pregnancy because of its association with fetal harm, including miscarriage and congenital abnormalities.

• Mycophenolate: Contraindicated during pregnancy because it is associated with an increased risk of miscarriage and congenital abnormalities.

• Cyclophosphamide: May harm the fetus and is generally avoided during pregnancy. Its use may be considered only in exceptional, life-threatening circumstances involving the mother or a vital organ, following specialist assessment of the risks and benefits.

Medical guidelines recommend avoiding methotrexate and mycophenolate during pregnancy and restricting cyclophosphamide use to exceptional, severe situations.

If you discover that you are pregnant while taking any of these medications, contact your physician immediately to assess the exposure and develop an appropriate plan. Do not make treatment decisions independently or delay seeking medical advice.

3. Treatment of Eye and Inner Ear Inflammation

Treatment depends on the affected organ and the severity of inflammation. Prompt intervention may be necessary to preserve visual and auditory function.

Eye Inflammation

• Consult an ophthalmologist if you develop eye pain, redness, light sensitivity, or blurred vision.

• Use appropriate eye drops based on the type of inflammation and only after infection has been ruled out.

• Systemic treatment, such as corticosteroids, may be required if inflammation is severe or other organs are involved.

Hearing Loss or Vertigo

• Arrange prompt hearing assessment if new or sudden hearing deterioration occurs.

• A physician should assess whether urgent treatment, including corticosteroids, is necessary.

• Auditory rehabilitation or cochlear implantation may be considered in some cases of permanent hearing loss, depending on the individual condition and specialist assessment.

Do not wait for a routine follow-up appointment if sudden hearing loss or rapidly worsening vision occurs. Prompt assessment and treatment may be important in reducing the risk of permanent damage.

4. If Cogan Syndrome Affects the Heart or Blood Vessels

Cogan syndrome may cause inflammation of large blood vessels, including the aorta, or affect the heart valves. If these complications occur during pregnancy, follow-up with a cardiologist and a team experienced in high-risk pregnancy becomes essential.

The assessment and monitoring plan may include:

• Echocardiography: To evaluate the heart valves and cardiac function.

• Vascular imaging: When necessary, selecting appropriate imaging techniques while considering safety during pregnancy.

• Monitoring blood pressure and cardiopulmonary symptoms: According to the level of risk.

• Delivery planning: Developing an appropriate birth plan if significant cardiovascular complications are present.

Severe chest pain, sudden shortness of breath, or fainting requires immediate emergency medical attention.

5. Follow-Up During Pregnancy and After Delivery

Regular medical follow-up helps monitor disease activity and identify complications early. The care plan should ideally include:

• Rheumatology follow-up: To assess inflammatory activity and adjust treatment when necessary.

• Eye and hearing assessments: To monitor changes in vision or hearing and address them promptly.

• Pregnancy monitoring: To assess blood pressure, fetal growth, and any additional risk factors.

• Postpartum follow-up: To reassess disease activity and medications and review treatment compatibility with breastfeeding if the mother wishes to breastfeed.

Can Pregnancy Be Successful with Cogan Syndrome?

Some women with Cogan syndrome may have an uncomplicated pregnancy, particularly when they receive close medical monitoring and an appropriate treatment plan. However, a successful outcome cannot be guaranteed. Risks depend on disease severity, cardiovascular involvement, treatment response, and other pregnancy-related factors.

The primary goal is to protect the health of both the mother and the fetus by controlling inflammation and selecting appropriate medications under the supervision of a specialized medical team.

Tips for Managing and Preventing Complications of Cogan Syndrome During Pregnancy

There is no established method for preventing Cogan syndrome itself because it is a rare inflammatory autoimmune disease whose exact causes are not fully understood. Nevertheless, the risk of complications can be reduced by detecting disease activity early, following a pregnancy-appropriate treatment plan, and maintaining regular medical follow-up.

Successful pregnancies have been reported in women with Cogan syndrome, but available information remains limited because the disease is rare. Therefore, each woman should have an individualized care plan that considers both her health and the health of her fetus.

1. Daily Tips to Protect the Mother and Fetus

Certain daily habits can support maternal health and improve safety, but they do not prevent Cogan syndrome flare-ups or replace medical treatment.

Rest and Activity Management

• Ensure that you get sufficient sleep and rest.

• Engage in light physical activity, such as walking, if your health condition and obstetrician's recommendations permit it.

• Avoid activities that increase the risk of falling if you experience vertigo or balance problems.

• Do not undertake prolonged or complete bed rest unless medically indicated. There is no evidence that bed rest prevents disease flare-ups, and prolonged inactivity may cause harm when it is not medically necessary.

Nutrition and Hydration

• Eat a balanced diet that includes vegetables, fruits, protein, and whole grains.

• Drink water regularly unless your physician advises you to restrict fluids.

• Take folic acid and prenatal supplements according to your physician's instructions.

• Avoid smoking and alcohol. Do not use herbal remedies or supplements marketed to boost immunity or treat inflammation without consulting your physician.

Eye and Ear Care

• Wear sunglasses if bright light increases eye discomfort, and consult an ophthalmologist if new symptoms develop.

• Do not use medicated eye drops without an appropriate prescription, especially corticosteroid-containing drops.

• Avoid inserting cotton swabs or cleaning materials into the ear canal.

• If you experience vertigo or balance problems, avoid driving and take precautions when using stairs until your condition has been assessed.

These measures may improve daily comfort and safety, but they do not treat the autoimmune inflammation responsible for the syndrome.

2. Medical Follow-Up to Help Reduce Complications

It is best to establish a clear follow-up schedule with your treating team rather than waiting for symptoms to appear or worsen. The frequency of examinations depends on disease activity, the organs affected, and the stage of pregnancy.

Area of Follow-Up	What Should Be Monitored?
Rheumatology and immunology	Disease activity, new symptoms, and inflammatory markers when indicated.
Ophthalmology	Visual acuity, eye pain, redness, and light sensitivity.
Hearing and balance	Hearing test results, changes in hearing, and new episodes of vertigo.
Cardiovascular system	Blood pressure and assessment of the heart and aorta when symptoms or suspected involvement warrant it.
Pregnancy and fetus	Fetal growth, blood pressure, and routine prenatal assessments according to the level of risk.

Your physician may recommend echocardiography or repeated hearing and eye examinations according to your condition, selecting pregnancy-appropriate investigations when necessary. There is no single monitoring schedule suitable for all pregnant women with Cogan syndrome.

3. How Can You Reduce the Risks of Medication During Pregnancy?

Medication review is one of the most important steps in reducing complications because some treatments used to control the disease may not be appropriate during pregnancy.

• Do not suddenly stop corticosteroids: If you are taking them, do not change the dose or discontinue treatment without medical guidance.

• Inform all your physicians about the pregnancy: Provide a complete list of medications and supplements you use, including nonprescription products.

• Review the treatment plan regularly: Your physician may select prednisolone or another suitable treatment based on the severity of inflammation and the stage of pregnancy.

• Avoid medications that are unsuitable during pregnancy: These include methotrexate and mycophenolate, which are contraindicated during pregnancy, and cyclophosphamide, which is generally avoided except in exceptional, severe circumstances under specialist supervision.

• Do not start specialized treatments independently: Biologic medications and intravenous immunoglobulin may be considered in selected cases, but their use requires careful assessment of the potential benefits and risks.

If you are planning a pregnancy, it is best to review your medications beforehand so that any necessary changes can be made safely. If you discover that you are pregnant while taking a medication that may harm the fetus, contact your physician promptly for an appropriate management plan.

4. When Should You Seek Urgent Medical Attention?

Do not wait for your routine follow-up appointment if new or severe symptoms develop. Seek urgent medical assessment if you experience any of the following:

• Sudden hearing loss or rapidly worsening hearing.

• Sudden blurred vision, severe eye pain, or pronounced light sensitivity.

• New, severe vertigo, especially if accompanied by difficulty walking or neurological symptoms.

• Severe chest pain, sudden shortness of breath, or fainting.

These symptoms may indicate active inflammation or complications involving the eyes, ears, heart, or blood vessels. Prompt medical evaluation is therefore essential to help prevent serious or permanent damage.