Special considerations in pregnant systemic sclerosis patients

ABSTRACT

Introduction: Evaluating the fertility and pregnancy outcomes in systemic sclerosis (SSc) women is challenging. Studies are still limited or subject to potential methodological biases.

Areas covered: This work is a comprehensive review of the literature. We discuss the potential impact of SSc on women’s pregnancy outcomes and the effects of pregnancy on SSc. We summarize the physiological changes during pregnancy and describe our experience.

Expert commentary: Although the miscarriage rate does not appear increased in SSc, women are exposed to a higher risk of premature birth and intrauterine growth restriction compared with the general population. Early diffuse cutaneous SSc and use of corticosteroids are risk factors, whereas folic acid use prevents against premature birth. All SSc women wishing to conceive should be counselled during a preconception visit. Physiological changes arising during pregnancy may be the source of clinical problems in SSc women with organs with limited capacities.

KEYWORDS:

• Systemic sclerosis
• connective tissue disease
• pregnancy
• scleroderma
• hypertension
• renal crisis
• preeclampsia
• placenta
• prematurity
• miscarriage

Acknowledgments

We are very grateful to Dr. Louise Devisme and Dr. Sarah Humez (Institute of Pathology, CHRU Lille, Université Lille 2) for providing histological pictures.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.