Morphea disease activity during pregnancy: A case series

Little is known about pregnancy in women with morphea. We aimed to describe the clinical presentation, pregnancy outcomes, and medical management of morphea during pregnancy. We conducted a case series of female patients of reproductive age (18-49 years) who were part of the longitudinal MAC (Morphea in Adults and Children) cohort seen in the outpatient dermatology clinic at the University of Texas Southwestern from July 2007 to February 2022. Women who were pregnant during research visits and had at least 6 months of follow-up in the MAC cohort were included. Data collected included demographics, morphea characteristics, pregnancy outcomes, and medication history. Median clinical disease activity and damage scores using the Localized Scleroderma Cutaneous Assessment Tool were recorded. Ten patients were pregnant during the study period. Five patients had pediatric-onset morphea and five had adult-onset morphea. Eight patients had linear and two had plaque morphea. Six patients had at least one morphea lesion on their abdomen. Median age at first pregnancy was 31 years (interquartile range [IQR], 26.0-35.8 years) and median duration of morphea was 13.5 years (IQR, 4.8-19.0 years). In seven patients, damage scores were stable with no increased morphea activity. Three patients (30%) experienced reactivation of morphea activity during pregnancy with a median Localized Scleroderma Activity Index of 4 (IQR, 2.5-10). Only one patient required immunosuppressive therapy during pregnancy for her morphea diagnosis. Seven of 10 patients had cesarean deliveries and one adverse fetal outcome was reported. In this small series, most patients maintained stability of their morphea and there were no adverse pregnancy outcomes directly related to morphea.