Scleroderma and pregnancy

Slate, William G.; Graham, Annie

doi:10.1016/0002-9378(68)90059-8

Cited by 56 publications

(12 citation statements)

References 4 publications

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“…Several studies of reproductive function in patients with scleroderma have been reported. A variety of adverse outcomes have been noted, including increased frequency of spontaneous miscarriage (2)(3)(4)(5)(6), prematurity (7)(8)(9), small babies (7,10), and infertility (2,10,11). Unfortunately, there has been little concordance of results from center to center.…”

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confidence: 99%

Fertility and pregnancy outcome in women with systemic sclerosis

Steen

Medsger

1999

Arthritis & Rheumatism

110

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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.

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Fertility and pregnancy outcome in women with systemic sclerosis

Steen

Medsger

1999

Arthritis & Rheumatism

110

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“…Maternal complications occurred in both of the patients reported here (hypertension and preeclampsia), and in 3 of the 6 patients reported by Donaldson (8,9) (hypertension, uterine rupture, and maternal death). Detailed information regarding maternal complications was not provided in the other 3 series reviewed above, although maternal death occurred in 1 patient in the series reported by Slate and Graham (7). The most frequent complication3 described in case reports have been hypertension or preeclampsia.…”

Section: Discussionmentioning

confidence: 99%

Pregnancy and systemic sclerosis

Ballou

Morley

Kushner

1984

Arthritis & Rheumatism

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Pregnancy has been reported infrequently in patients with systemic sclerosis. Consequently, the outcome and appropriate management of such patients is uncertain. We review the obstetric experience of 19 female patients with systemic sclerosis, and report 2 women in whom 3 pregnancies occurred during the course of disease. Maternal complications included hypertension during 2 of these pregnancies and congestive heart failure during 1. There were 2 premature deliveries, although all 3 infants survived. Our experience with these patients and a review of the available literature suggest that, in patients with systemic sclerosis, fertility may be reduced and complications of pregnancy may be more frequent.The occurrence of pregnancy in women who have systemic sclerosis (scleroderma) appears to be uncommon. The infrequency of reports of this association has led to somewhat divergent views concerning the outcome and management of such patients. A review in the obstetric literature recommends consideration of early therapeutic abortion and permanent sterilization because of high maternal morbidity ( I ) . No firm conclusions can be obtained from the nonobstetric literature. The 1966 Rheumatism Review recorded that no effect on pregnancy was noted in We have recently managed 2 scleroderma patients through the course of 3 pregnancies. Herein we describe our experience with these women and survey the reported series published in the English language literature. PATIENTS AND METHODSPatient 1. A 26-year-old black woman developed Raynaud's phenomenon and digital ulcerations in 1975. She subsequently developed sclerodactyly, telangiectasia, diffuse proximal and distal cutaneous scleroderma, myosjtis, gastrointestinal involvement (including esophageal dysmotility and wide-mouth colonic pseudodiverticula), and pulmonary involvement characterized by radiographic interstitial fibrosis, restrictive pulmonary function, and mild resting hypoxemia. She remained normotensive with normal renal function.Serologic evaluation revealed a positive antinuclear factor with a nucleolar pattern and negative test results for rheumatoid factor, anti-DNA, anti-RNP, and anti-Sm antibodies. Her obstetric history included 4 pregnancies, with I term and 3 premature deliveries resuljing in 2 neonatal deaths and 2 living children. All pregnancies had occurred prior to the onset of scleroderma.She became pregnant for the fifth time in 1979. During the pregnancy she was maintained on a regimen of prednisone 15 mg daily and methyldopa 500 mg 3 tiyes daily. These medications were given for treatment of myositis and Raynaud's phenomenon, respectively. She remained normotensive and noted moderate improvement in her digital ulcers.At 32 weeks' gestation she was hospitalized with a blood pressure of 154/108 and facial and lower extremity edema. Serum creatinine was 0.5 mg/dl and urinalysis showed 2+ proteinuria. Her hypertension proved refractory to management with bed rest, methyldopa, and intravenous

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“…En el pasado había pocos reportes de embarazos en pacientes con ES debido, en parte, a que la edad pico de inicio de la enfermedad es de entre 45 a 55 años, y al hecho de que los informes de casos iniciales mostraban desenlaces desalentadores tanto para las madres como para los bebés [10][11][12][13][14] . Hace 25-30 años, era relativamente común que los médicos recomendaran a sus pacientes con ES no concebir e incluso abortar si llegara a suceder debido al supuesto riesgo elevado de complicaciones fatales para la madre y el bebé.…”

Section: Embarazo Y Esclerosis Sistémicaunclassified