Pregnancy in women with systemic sclerosis

Abstract

We assessed fetal morbidity and mortality in women with systemic sclerosis (SSc). Women with a history of SSc and a concomitant pregnancy completed a detailed questionnaire about the pregnancy. These 48 subjects were age‐matched and race‐matched to 2 other groups of women (a rheumatoid arthritis group and a control group from the same neighborhood), all of whom had been pregnant at least once. There were no differences in the frequencies of miscarriage or perinatal death in the SSc group compared with the 2 control groups. Preterm births occurred slightly more frequently in both SSc patients and rheumatoid arthritis patients compared with the neighborhood control subjects. There were significantly more small full‐term infants born to women with SSc. Interestingly, the increase in preterm births and small full‐term babies occurred with equal frequency prior to and after the onset of disease. Although close monitoring for premature birth and intrauterine growth retardation is necessary, we conclude that an uneventful, healthy pregnancy is possible for women with SSc. Those with early, rapidly progressive, diffuse skin thickening should avoid becoming pregnant since, intrinsically, they are at higher risk of developing renal crisis.

Vascular Complications of Systemic Sclerosis during Pregnancy

“…It is likely for this reason that women with SSc in past decades had been strongly advised against pregnancy and often counseled to terminate pregnancies that have occurred [12]. More recently, a series of retrospective and prospective studies have provided more detailed analysis of pregnancy outcomes and have demonstrated that, for most women with SSc, pregnancy outcomes are reasonably good [13–18]. Reported rates of early pregnancy loss of 14% ‒ 15% [13, 14] are somewhat increased from the estimated 10% in the general population.…”

“…More recently, a series of retrospective and prospective studies have provided more detailed analysis of pregnancy outcomes and have demonstrated that, for most women with SSc, pregnancy outcomes are reasonably good [13–18]. Reported rates of early pregnancy loss of 14% ‒ 15% [13, 14] are somewhat increased from the estimated 10% in the general population. Late pregnancy losses were few, and generally occurred in women with severe diffuse SSc [14, 16].…”

“…Late pregnancy losses were few, and generally occurred in women with severe diffuse SSc [14, 16]. Preterm delivery rates have ranged from 8%to40% [13, 14, 16]. The majority of preterm deliveries were on or after gestational age 34 [14].…”

Severe fibrotic changes and altered expression of angiogenic factors in maternal scleroderma: placental findings

“…SSc occurs in women of childbearing age approximately five times more frequently than in men 2. Pregnancy outcome studies showed an increased incidence of perinatal loss as well as an increased risk of preterm births and growth retardation in maternal scleroderma 2 3 4 5.…”

“…SSc occurs in women of childbearing age approximately five times more frequently than in men 2. Pregnancy outcome studies showed an increased incidence of perinatal loss as well as an increased risk of preterm births and growth retardation in maternal scleroderma 2 3 4 5. Detailed studies of placental findings in SSc are limited, and few pathological descriptions showed decidual vasculopathy, placental mesenchymal villous dysplasia, infarcts and reduction of uteroplacental perfusion 5 6 7.…”