Fertility and pregnancy outcome in women with systemic sclerosis

Abstract

Objective. To determine fertility and pregnancy outcome in women with systemic sclerosis (SSc; scleroderma) who had disease onset before age 45 years.Methods. All living women with scleroderma who had first been evaluated at the University of Pittsburgh Scleroderma Clinic after January 1, 1972 were sent a detailed self-administered questionnaire in 1986 specifically concerning pregnancy outcomes and infertility. This group was compared with 2 race-and age-matched control groups, one comprising women with rheumatoid arthritis (RA) and one comprising healthy neighborhood women identified by random-digit dialing. We determined the number, history, treatment, and outcome of women who either had never been pregnant or had attempted to become pregnant unsuccessfully for more than 1 year. We also obtained data regarding pregnancy outcomes, including the frequency of miscarriage, premature births, small full-term infants, perinatal deaths, and births of live healthy infants.Results. The study group comprised 214 women with SSc, 167 with RA, and 105 neighborhood controls. There were no significant differences in the overall rates of miscarriage, premature births, small full-term births, or neonatal deaths between the 3 groups. Women with SSc were more likely than those without SSc to have adverse outcomes of pregnancy after the onset of their rheumatic disease, particularly premature births (also seen in RA women after disease onset) and small full-term infants. Although a significantly greater number of women with SSc had never been pregnant, there were no significant differences in the frequency of never having been pregnant or of infertility in the 3 groups after adjustment for contributing factors.Conclusion. This study indicates that women with SSc have acceptable pregnancy outcomes compared with those of women with other rheumatic disease and healthy neighborhood controls. Infertility was not a frequent problem. We believe that there are no excessive pregnancy risks to women with SSc or their infants. However, a well-timed pregnancy with careful obstetric monitoring will maximize the likelihood of a successful outcome.

Pregnancy and autoimmune connective tissue diseases

“…In a US study based on the 2002–2004 Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project, SSc was associated with increased risk of hypertensive disease of pregnancy, including preeclampsia, IUGR and increased length of hospital stay [56]. Retrospective data on 214 women with SSc, 167 women with RA, and 2015 healthy controls in the US have also identified an increase in premature births and low birth weight for babies born to SSc mothers [57]. These finding were later confirmed in a study of pregnancy outcomes in an Italian multicenter study of 109 pregnancies among 99 women with SSc from 2000 to 2010, in which data was obtained prospectively starting a year before conception [58].…”

Special considerations in pregnant systemic sclerosis patients

“…Furthermore, early reports were first based on small or retrospective cohorts [4][5][6][7][8][9]. Furthermore, early reports were first based on small or retrospective cohorts [4][5][6][7][8][9].…”

“…published a prospective study but with self-administered questionnaire [7]. For those reasons, data were limited or controversial and conclusions could not be drawn.…”

Miscarriage but not fecundity is associated with progression of joint destruction in rheumatoid arthritis

“…12 However, this was not confirmed in a further study in 1999, where fecundity in 167 rheumatoid patients was comparable to that of 105 neighbourhood controls. 13 Thus the impact of rheumatoid arthritis on fertility and fecundity before disease onset has not been fully elucidated.…”