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Pregnancy in Women With Systemic Sclerosis

From the Division of Rheumatology, Immunology and Allergy, Department of Medicine, Georgetown University, Washington, DC.

Address reprint requests to: Virginia D. Steen, MD, Division of Rheumatology, Georgetown University Medical Center, 3800 Reservoir Road, NW, LL Gorman Building, Washington, DC 20007-2197, E-mail: steenv{at}gunet.georgetown.edu

Objective: To determine pregnancy outcomes in women with systemic sclerosis.

Methods: Women of childbearing age with systemic sclerosis seen at the University of Pittsburgh between 1987 and 1996 were observed prospectively. Pregnancy outcomes included abortion, miscarriage, preterm and term birth, and perinatal death. Complications of pregnancy and scleroderma were determined during and after pregnancy.

Results: Fifty-nine women with systemic sclerosis had 91 pregnancies during the 10-year period. No increase in the frequency of miscarriage was found, except in those with long-standing diffuse scleroderma. Preterm births occurred in 29% of pregnancies, and all but one of the infants survived. Symptoms related to scleroderma, particularly Raynaud phenomenon, improved during pregnancy, but esophageal reflux became worse. After pregnancy, some women with diffuse scleroderma had increased skin thickening. There were three cases of renal crisis during pregnancy, all in women with early diffuse scleroderma. Four women had five healthy infants while taking angiotensin-converting-enzyme inhibitors.

Conclusion: Women with systemic sclerosis can safely have healthy pregnancies. Those with early diffuse scleroderma should wait until their disease stabilizes before becoming pregnant to decrease the risk of renal crisis. High-risk pregnancy management should be standard for all scleroderma pregnancies because of the high frequency of premature births.

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