[Pregnancy in systemic sclerosis]

In the 1980's, pregnancies in systemic sclerosis (SSc) patients were considered to be at high risk for poor foetal and maternal outcome. Retrospective studies found 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. The use of ACE inhibitors is recommended in this case despite the risk of teratogenicity. 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 who are at a greater risk for developing serious cardiopulmonary and renal problems early in the disease. Hydroxychloroquine and low doses of steroids may be safely used. In order to minimize risks, a multidisciplinary approach is necessary to suggest the best timing for a pregnancy and provide adequate supportive treatment to SSc patients during the pregnancy.