Pregnancy in Systemic Sclerosis: Results of a Systematic Review and Metaanalysis

Blagojević, Jelena; Alodhaibi, Khitam; Aly, Aly Mousaad; Bellando-Randone, Silvia; Lepri, Gemma; Bruni, Cosimo; Moggi-Pignone, Alberto; Guiducci, Serena; Mecacci, Federico; Matucci‐Cerinic, Marco; Fürst, Daniel E.

doi:10.3899/jrheum.181460

Cited by 39 publications

(30 citation statements)

References 37 publications

(50 reference statements)

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“…Patients with SSc have a 2.3 times higher chance of cesarean delivery. 18 In this case, vaginal delivery was preferable because there was no vaginal constriction or contractures. We warmed the delivery room and intravenous fluids to prevent any problems related to Raynaud phenomenon during delivery.…”

Section: Discussionmentioning

confidence: 88%

“…17 A recent systematic review reported that pregnancies involving SSc had a higher risk of miscarriage, fetuses with IUGR, preterm birth, and newborns with a low birth weight. 18 Additionally, patients with SSc had a 2.8 times higher chance of developing gestational hypertension. As a result, more frequent evaluation of blood pressure, urinalysis, and renal function is required, and management should be provided in a specialized center, with a multidisciplinary team capable of identifying and promptly treating complications.…”

Section: Discussionmentioning

confidence: 99%

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Management of pregnancy with diffuse cutaneous systemic sclerosis: a case report and literature review

2021

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Diffuse cutaneous systemic sclerosis may occur in women of childbearing age. Pregnancies in this population are associated with a markedly increased risk of adverse obstetric and maternal outcomes even before the onset of symptoms related to sclerosis. We report a case involving the management and outcome of pregnancy in a 30-year-old woman with diffuse cutaneous systemic sclerosis. The course of her pregnancy was good and was assisted by a group consultation including obstetricians and rheumatologists. Vaginal delivery was the patient’s preferred choice because she had irregular skin tightness in her lower abdominal skin. She underwent induction of labor and combined spinal-epidural analgesia, and successfully delivered. Importantly, these pregnancies need to be planned, where possible, to allow the opportunity to counsel women and their partners in advance and to decrease any risks. These pregnancies should be considered high risk, and they require close antenatal monitoring and good supervision from an expert multidisciplinary team experienced in high-risk pregnancies. The management of delivery for patients with cutaneous systemic sclerosis is challenging, and vaginal delivery with labor analgesia is an alternative option to cesarean section.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Management of pregnancy with diffuse cutaneous systemic sclerosis: a case report and literature review

2021

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“…Women with SSc present higher frequency of adverse events during pregnancy, including miscarriage, intrauterine growth restriction and gestational hypertension. [23]. Reduced levels of EPCs were found in patients affected by SLE [21]; in patients with SLE, pregnancy is considered at high risk, both for the maternal and foetal outcome [24].…”

Section: Discussionmentioning

confidence: 99%

“…Endothelial dysfunction is a known feature of some autoimmune connective tissue diseases; altered levels and function of EPCs have been detected in rheumatoid arthritis (RA), systemic sclerosis (SSc) and systemic lupus erythematosus (SLE) [16][17][18][19][20][21]. Interestingly, these conditions are associated with increased risk of adverse obstetric outcome [22][23][24].…”

Section: Introductionmentioning

confidence: 99%

Circulating endothelial progenitor cells during pregnancy in multiple sclerosis

Mallucci

Beneventi

Bergamaschi³

et al. 2020

Neurol Sci

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Background Endothelial progenitor cells (EPCs) have been shown to increase during physiological pregnancy and are believed to play a fundamental role in the process of placentation. Reduced levels of EPCs during pregnancy have been associated with preeclampsia and miscarriage. Women with multiple sclerosis (MS) are not at increased risk of preeclampsia nor of general adverse obstetric outcome, in contrast with some other autoimmune diseases. Objective The aim of this study was to evaluate circulating EPCs levels in pregnant patients with MS. Methods CD34+ and CD133+ were longitudinally detected by flow cytometry in the maternal plasma of 29 healthy controls and 9 MS patients and in the cord blood of their newborns. Results EPCs were affected by pregnancy with the same trend in both groups (CD34+ p = 0.0342; CD133+ p = 0.0347). EPCs during pregnancy were increased in MS (mean ± SD: CD34+ cells 0.038 ± 0.010; CD133+ 0.024 ± 0.009) with respect to healthy controls (mean ± SD: CD34+ cells 0.022 ± 0.006; CD133+ 0.016 ± 0.004), CD34+ p = 0.0004; CD133+ p = 0.0109. EPCs levels of the cord blood of MS patients' newborns mild correlated with maternal EPC levels at delivery (CD34+: spearman's Rho 0.658, p = 0.054; CD133+: spearman's Rho 0.758, p = 0.018). Conclusions This work identified increased circulating EPC levels during pregnancy, following the same trend both in MS patients and healthy controls. Despite the similar trend, the levels of circulating EPCs were significantly higher in MS patients with respect to the control population. A correlation was also found in MS patients between cord blood EPCs and circulating EPCs at delivery.

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“…59 Patients with systemic sclerosis who achieve pregnancy have a higher prevalence of adverse pregnancy outcomes (odds ratio [OR]: 1.9 for miscarriage; 3.8 for low birth weight; 2.4 for preterm birth). However, optimisation of disease control prior to conception decreases this risk, 60 although progression of disease during pregnancy was observed in 14.3%. Close monitoring in specialist centres with support from obstetrics, rheumatology, and respiratory can aid in optimising outcomes.…”

Section: Systemic Sclerosismentioning

confidence: 99%

Management of Pregnancy in Rheumatic Disease

Maguire

O’Shea

2021

EMJ Rheumatol

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Managing patients with rheumatic diseases (RMD) during pregnancy and the postpartum period can be a challenge for both rheumatologists and obstetricians. While disease activity during the course of pregnancy varies with regard to the presence of underlying conditions, maintenance of remission from conception through to delivery increases the chances of an uncomplicated pregnancy. A period of remission of at least 6 months prior to conception increases the chance of a successful conception while decreasing the risk of flares during pregnancy. For this reason, discussion of pregnancy in females with RMDs should begin prior to conception with risk stratification and pregnancy planning. This allows for the transfer to pregnancy-compatible medications, disease stabilisation, determination of autoantibody status, and evaluation of end-organ damage. During pregnancy, where possible, disease activity should be monitored with scores modified to allow use in pregnancy. Prompt recognition and treatment of active disease is essential to minimise the risk to the pregnancy. Systemic lupus erythematosus and axial spondyloarthropathy can present diagnostic dilemmas due to overlap of symptoms of disease activity and normal pregnancy. Patients with end-organ involvement, such as systemic lupus erythematosus or systemic sclerosis, face a higher risk of adverse pregnancy outcomes and disease progression. Close monitoring of patients with RMD should be done by both obstetrics and rheumatology, with regular communication between specialties. Medications should be reviewed at each stage of pregnancy to ensure compliance with the current American College of Rheumatology (ACR) guidelines and the adequate treatment of RMDs.

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Pregnancy in Systemic Sclerosis: Results of a Systematic Review and Metaanalysis

Cited by 39 publications

References 37 publications

Management of pregnancy with diffuse cutaneous systemic sclerosis: a case report and literature review

Management of pregnancy with diffuse cutaneous systemic sclerosis: a case report and literature review

Circulating endothelial progenitor cells during pregnancy in multiple sclerosis

Management of Pregnancy in Rheumatic Disease

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