Pregnancy in systemic sclerosis

While in the past, pregnant SSc patients were thought to be at high risk for poor fetal and maternal outcome, at present, careful planning, close monitoring and appropriate therapy allows these patients to have a successful pregnancy. Retrospective studies clearly show an increased frequency of pre-term births and small full-term infants but the frequency of miscarriage and neonatal survival rate did not differ from healthy controls. The worst life-threatening complication of a pregnancy is scleroderma renal crisis: despite the fact that ACE inhibitors are associated with congenital abnormalities and are relatively contraindicated in pregnancy, in this case their use is recommended. In order to avoid complications, pregnancies in SSc should be planned when the disease is stable, and should be avoided in rapidly progressing diffuse SSc as such patients are at a greater risk for developing serious cardiopulmonary and renal problems early in the disease. HCQ, intravenous immunoglobulins (if blood pressure is not high and renal function is normal) and low doses of steroids may be safely used. In case of rapid worsening of disease activity, elective termination in the first trimester and an induced pre-term birth in the last trimester may be suggested. In order to minimize risks, a multidisciplinary team should assist scleroderma patients to suggest the best timing for a pregnancy and to tailor adequate supportive treatment during the pregnancy.