Background: Data about the obstetric outcomes of pregnant women with Systemic Sclerosis (SSc) mainly derive from retrospective studies. Moreover, little evidence is available to define if pregnancy impacts on SSc course and if children of SSc mothers have a normal post-natal development.

Objectives: To assessed the obstetric, pediatric and rheumatologic outcomes of SSc pregnancies in a prospective controlled study

Methods: Prospective recruitment of three cohorts.

1 ) 110 pregnant women with SSc.

2 ) 218 control pregnancies without systemic autoimmune diseases

3 ) 78 non-pregnant control SSc with a matching subject in cohort-1.

SSc was characterized for disease activity, severity, cutaneous/organ involvement and therapy. Women and their offspring were followed until 21 months after enrollment (ie, 12 months after expected delivery).

Results: Gestational and neonatal outcomes

Miscarriages and fetal death occurred in 7% and 5% of SSc pregnancies. Compared to control pregnancies, SSc pregnancies had higher rates of gestational hypertension (12% Vs 4%, p=0.004), pre-eclampsia (9% Vs 1%, p=0.002), fetal growth-restriction (13% Vs 4%, p=0.004), prematurity (26% Vs 7%, p<0.001) and cesarean section (52% Vs 4%, p=0.002). Newborns from SSc mothers weighted less (2773 Vs 3243g, p<0.001), were more frequently small for gestational age (SGA, 18% Vs 12%, p=0.05) and required neonatal-intensive care unit (ICU) more frequently (12% Vs 1%, p<0.001). Rates of newborn malformation/death, and one year-pediatric outcomes were similar.

Univariate and multivariate analyses were performed for relevant outcomes. For example, pre-eclampsia positively associated with baseline skin score and its evolution during pregnancy (p=0.015 and 0.013), immunosuppressive agents, bosentan and iloprost at baseline (p=0.001, 0.041 and 0.007), and twin pregnancy(p=0.006). Multivariate logistic regression for pre-eclampsia in SSc identified baseline arterial hypertension, immunosuppressive agents or of iloprost, twin pregnancy and assisted conception as risk factors (p=0.000, 0.002, 0.0025, 0.000 and 0.027), and baseline calcium channel blockers as protective factors (p=0.001).

SSc course during pregnancy

As compared to matched non-pregnant SSc, SSc pregnant women had lower Medsger disease severity index (0.6 +/-0.9 Vs 1.0 +/-1.1, p=0.022), health assessment questionnaire (HAQ, 0.21 +/-0.38 Vs 0.40 +/-0.55, p=0.026), and lower rate of iv iloprost (21% Vs 42%, p=0.006). Pregnant and non-pregnant SSc women had a similar disease course during the 21 months of follow-up, despite a lower use of immunosuppressive agents (17% Vs 36%, p=0.014). Two scleroderma-renal-crises (SRC) occurred during pregnancy (one was a relapse of a previous SRC; the other occurred at week 33, and resolved after premature delivery of a SGA newborn and ACE-inhibitors, preventing differentiation from pre-eclampsia).

Conclusion: SSc pregnancies have generally a favorable obstetric/pediatric outcome, albeit at a higher risk of gestational hypertension, pre-eclampsia, fetal growth restriction, prematurity, delivery of SGA newborn and requirement of neonatal-ICU. Pregnancy does not impact on SSc course, although SRC during late pregnancy and pre-eclampsia might be hardly discriminated.

REFERENCES:

[1]Taraborelli M et al., Arthritis Rheum, 2012.

Disclosure of Interests: None declared