Brief Report: Successful pregnancies but a higher risk of preterm births in patients with systemic sclerosis: An Italian multicenter study
Authors: Taraborelli Mara , Ramoni Véronique , Brucato Antonio , Airò Paolo , Bajocchi Gianluigi , Bellisai Francesca , Biasi Domenico , Blagojevic Jelena , Canti Valentina , Caporali Roberto , Caramaschi Paola , Chiarolanza Ilaria , Codullo Veronica , Cozzi Franco , Cuomo Giovanna , Cutolo Maurizio , De Santis Maria , De Vita Salvatore , Di Poi Emma , Doria Andrea , Faggioli Paola , Favaro Maria , Ferraccioli Gianfranco , Ferri Clodoveo , Foti Rosario , Gerosa Alessandro , Gerosa Maria , Giacuzzo Sarah , Giani Leopoldo , Giuggioli Dilia , Imazio Massimo , Iudici Michele , Iuliano Annamaria , Leonardi Roberto , Limonta Massimiliano , Lojacono Andrea , Lubatti Chiara , Matucci‐Cerinic Marco , Mazzone Antonino , Meroni Marianna , Meroni Pier Luigi , Mosca Marta , Motta Mario , Muscarà Marina , Nava Simona , Padovan Melissa , Pagani Giorgio , Paolazzi Giuseppe , Peccatori Susanna , Ravagnani Viviana , Riccieri Valeria , Rosato Edoardo , Rovere‐Querini Patrizia , Salsano Felice , Santaniello Alessandro , Scorza Raffaella , Tani Chiara , Valentini Gabriele , Valesini Guido , Vanoli Massimo , Vigone Barbara , Zeni Silvana , Tincani Angela ,   on behalf of the IMPRESS Investigators
Published: December 2011

Objective

To assess fetal and maternal outcomes in women with systemic sclerosis (SSc).

Methods

Prospectively collected data on 99 women with SSc from 25 Italian centers were analyzed retrospectively. Women with SSc were observed during 109 pregnancies (from 2000 to 2011), and outcomes were compared to those in the general obstetric population (total of 3,939 deliveries). The maternal age at conception was a mean ± SD 31.8 ± 5.3 years, and the median disease duration at conception was 60 months (range 2–193 months).

Results

SSc patients, compared to the general obstetric population, had a significantly increased frequency of preterm deliveries (25% versus 12%) and severe preterm deliveries (<34 weeks of gestation) (10% versus 5%), intrauterine growth restriction (6% versus 1%), and babies with very‐low birth weight (5% versus 1%). Results of multivariable analysis showed that corticosteroid use was associated with preterm deliveries (odds ratio [OR] 3.63, 95% confidence interval [95% CI] 1.12–11.78), whereas the use of folic acid (OR 0.30, 95% CI 0.10–0.91) and presence of anti–Scl‐70 antibodies (OR 0.26, 95% CI 0.08–0.85) were protective. The disease remained stable in most SSc patients, but there were 4 cases of progression of disease within 1 year from delivery, all in anti–Scl‐70 antibody–positive women, 3 of whom had a disease duration of <3 years.

Conclusion

Women with SSc can have successful pregnancies, but they have a higher‐than‐normal risk of preterm delivery, intrauterine growth restriction, and babies with very‐low birth weight. Progression of the disease during or after pregnancy is rare, but possible. High‐risk multidisciplinary management should be standard for these patients, and pregnancy should be avoided in women with severe organ damage and postponed in women with SSc of recent onset, particularly if the patient is positive for anti–Scl‐70 antibodies.