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Systemic Sclerosis Increases Risk of Adverse Pregnancy Outcomes

“In recent years, the habit of delaying pregnancy because of social and economic reasons has become more common, increasing the possibility of getting pregnant after the onset of the disease," investigators stated. "This fact makes pregnancy a more frequent issue to deal with in the present years.”

Patients with systemic sclerosis (SSc) had an increased risk of adverse pregnancy outcomes (APO), including higher rates of preeclampsia, miscarriages, preterm deliveries, and small-for-gestational-age (SGA), when compared with healthy controls (HC), according to a study published in Arthritis Research and Therapy.1

“The mean age of onset of the disease is in the early 40s; therefore, most SSc patients are already mothers when the disease occurs,” investigators stated. “In recent years, the habit of delaying pregnancy because of social and economic reasons has become more common, increasing the possibility of getting pregnant after the onset of the disease. This fact makes pregnancy a more frequent issue to deal with in the present years.”

The retrospective study compared a total of 154 pregnancy and disease outcomes of women with SSc (n = 21), HCs (n = 40), systemic lupus erythematosus (SLE) (n = 26), and antiphospholipid syndrome (APS) (n = 31) at the High-Risk Pregnancy Unit between 2008 and 2019. The primary outcome was analyzing the number of miscarriages, neonatal deaths, fetal deaths, preterm births, SGA, and intrauterine growth restriction (IUGR). Changes in disease activity in patients with SSc related to pregnancy were also reported. Women were followed throughout pregnancy and up to 1 year post-delivery.

APO risk was significantly higher in women with SSc when compared to both the HC cohort (60.6% vs 10.0%; OR = 14.42; 95% CI 3.70–56.18, p = 0.001) as well as patients with SLE (60.6% vs 37.5%; OR = 3.56; 95% CI 1.29–9.83, p = 0.014). When compared with HC, pregnant women with SSc also had a higher risk of SGA newborns (21.2% vs 0%; p = 0.003), first trimester miscarriage (15% vs 0 %; p = 0.016), and preeclampsia (12% vs 0%, p = 0.038). Further, patients with SSc reported more preterm deliveries than both HC (24.2% vs 5%; OR = 6.08; 95% CI 1.19–31.02, p = 0.036) and patients with SLE (24.2% vs 7.5%, OR = 5.68; 95% CI 1.1–29.38, p = 0.038).

Disease activity did not fluctuate in patients with SSc during pregnancy and remained stable up to 1 year after delivery. There were no neonatal or perinatal deaths, no newborns had immediate complications, and no newborns needed to be admitted to the intensive care unit.

Data was collected directly through the clinic, not assessed via questionnaires, which strengthened the study. Further, comparing patients with SSc to other autoimmune diseases that are often linked with pregnancy morbidity, as well as the HC group, provided new insights, especially regarding SLE and SSc.

However, the retrospective design and small sample size limited the study. As investigators did not test for the entire spectrum of SSc-specific antibodies, the range of results may have been restricted. Lastly, there were no miscarriages, a common APO that occurs in 10-15% of pregnancies in the general population, reported in the HC cohort. This may have been because controls attended a high-risk clinic and were more likely to see better outcomes.

“The frequency of pregnancies in SSc patients has notably increased in recent years, and women and their health care providers need extensive information about the possible outcomes of their pregnancies,” investigators concluded. “Further studies, likely multicentric, with larger patient populations, are needed to improve our knowledge. A large, multicenter, prospective observational study of pregnancy in SSc (International Multicentric Study on PREgnancy in Systemic Sclerosis (IMPRESS 2)) is currently ongoing and results are awaited.”

Reference:

Barilaro, G., Castellanos, A., Gomez-Ferreira, I., Lledó, G., Della Rocca, C., Fernandez-Blanco, L., Cervera, R., Baños, N., Figueras, F. and Espinosa, G., 2022. Systemic sclerosis and pregnancy outcomes: a retrospective study from a single center. [online] Available at: <https://arthritis-research.biomedcentral.com/articles/10.1186/s13075-022-02783-0> [Accessed 28 April 2022].