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Systemic sclerosis and pregnancy outcomes: a retrospective study from a single center
Giuseppe Barilaro1, Aleida Castellanos2, Inês Gomez-Ferreira1
1Department of Autoimmune Diseases, Hospital Clinic, Universitat de Barcelona, Villarroel, 08036, Barcelona, Catalonia, Spain.
Arthritis Research & Therapy
|April 28, 2022
Summary
Pregnancy in women with systemic sclerosis (SSc) significantly increases risks for adverse outcomes like miscarriage and preterm birth compared to healthy controls. Multidisciplinary care is crucial for managing SSc pregnancies.
Area of Science:
- Rheumatology
- Obstetrics
- Maternal-Fetal Medicine
Background:
- Pregnancy outcomes in systemic sclerosis (SSc) are not well-documented.
- Existing literature suggests increased rates of preterm delivery and intrauterine growth restriction (IUGR) in SSc pregnancies.
- Comparisons of pregnancy outcomes between SSc, antiphospholipid syndrome (APS), and systemic lupus erythematosus (SLE) are lacking.
Purpose of the Study:
- To compare pregnancy and disease outcomes in women with SSc against age-matched cohorts of SLE patients, APS patients, and healthy controls (HC).
- To evaluate the frequency of adverse pregnancy outcomes (APO) in SSc pregnancies.
- To assess SSc activity variations during pregnancy and postpartum.
Main Methods:
- A retrospective study involving 154 pregnancies from SSc, SLE, APS patients, and HC, prospectively followed from 2008 to 2019.
- Primary outcome: composite endpoint of miscarriages, fetal deaths, IUGR, preeclampsia, neonatal deaths, preterm birth, and small-for-gestational-age (SGA) newborns.
- Secondary endpoints: individual adverse pregnancy outcomes; SSc activity assessment.
Main Results:
- The risk of APO was significantly higher in SSc patients compared to HC (60.6% vs 10.0%) and SLE patients (60.6% vs 37.5%).
- SSc pregnancies showed increased rates of first-trimester miscarriage (15%), preeclampsia (12%), SGA newborns (21.2%), and preterm deliveries (24.2%) compared to HC.
- Preterm deliveries were also more frequent in SSc pregnancies compared to SLE patients (24.2% vs 7.5%).
Conclusions:
- Women with SSc face a substantially increased risk of adverse pregnancy outcomes, including miscarriages, preeclampsia, SGA newborns, and preterm deliveries, compared to healthy controls.
- SSc pregnancies also exhibit a higher rate of preterm deliveries when compared to SLE pregnancies.
- High-risk, multidisciplinary management is strongly recommended for pregnant women with SSc.
