Pregnancy outcomes in systemic sclerosis before and after diagnosis: a retrospective nationwide cohort study

Pregnancy outcomes in women with systemic sclerosis (SSc) were evaluated in a nationwide cohort study. The impact of the disease on pregnancy outcomes was further assessed by comparing outcomes before and after the diagnosis of systemic sclerosis.

A retrospective, nationwide, multicenter study was conducted under the supervision of the Ministry of Health. A nationwide cohort was between 1 January 2018, and 31 October 2025, including female patients with at least two recorded ICD codes for SSc (M34 subcategories) at an interval of at least 1 month, who were identified as pregnant before (pre-SSc) or after SSc (post-SSc) based on ICD-10 codes (Z32, Z33, Z34, Z35). The initiation of data collection was set as 1 January 2018, because complete birth outcome records were available in the database from that date onward. Patients were categorized into pre-SSc and post-SSc groups according to the timing of pregnancy relative to the diagnosis of SSc.

Among 43,663 patients diagnosed with SSc, data from a total of 4914 pregnancies/pregnancy outcomes were retrospectively examined. Abortion was more frequent in women with SSc (11.70% in the pre-SSc group [relative risk (RR) 1.64, 95% CI 1.33-2.03], and 10.64% in the post-SSc group [RR 1.48, 95% CI 1.11-1.96]). The risk of gestational diabetes was significantly increased in both groups, with a greater increase observed in the pre-SSc group (RR 6.66); similarly, hypertensive disorders of pregnancy were more frequent in the pre-SSc group (RR 8.03). Puerperal complications were observed in 2.54% of the pre-SSc group and 3.12% (n = 22) of the post-SSc group (RR 1.85 and 2.28, respectively, compared with healthy controls).

Our results suggest that women with SSc are at increased risk; however, successful pregnancies are possible under appropriate multidisciplinary care.