title: Influence of prior pregnancies on disease course and cause of death in systemic sclerosis.
abstract: BACKGROUND
  Microchimerism from fetal or maternal cells transferred during pregnancy has been implicated in the pathogenesis of systemic sclerosis (SSc).
  
  
  OBJECTIVE
  To determine whether a prior pregnancy influenced disease progression and cause of death in patients with SSc.
  
  
  METHODS
  The patients comprised a retrospective study cohort of 111 women with SSc: 78 patients with prior pregnancies (PP) and 33 who were never pregnant (NP), followed up at Thomas Jefferson University. Differences in age at onset, disease subset, organ involvement, cause of death, and type of antinuclear autoantibodies were evaluated statistically, including regression analysis.
  
  
  RESULTS
  The age at onset of SSc in NP patients was 32.0 years compared with 45.7 years in patients with one or two prior pregnancies (p<0.0001), 46.6 years in patients with three or four pregnancies (p<0.0001), and 51.3 years in patients with five to seven pregnancies (p<0.0005). In the 16 patients who had an elective pregnancy termination, 14/16 (87.5%) had diffuse SSc v 2/16 (12.5%) with limited SSc (p<0.0001; odds ratio (OR)=49.0). Of the NP women, 7/30 (23%) died from SSc related causes v 3/78 (4%) women who had pregnancies (p=0.0058; OR=7.6). A carbon monoxide transfer factor (TLCO) of <60% and disease duration >10 years was found in 10/13 (77%) NP patients v 10/23 (43%) patients who had pregnancies (p=0.05; OR=4.7), and a TLCO <50% and disease duration >10 years was identified in 7/13 (54%) NP patients v 6/23 (26%) of the patients who had pregnancies (p=0.09; OR=3.2).
  
  
  CONCLUSIONS
  There are differences in the age at onset, clinical course, severity of lung involvement, and cause of death in women who develop SSc before pregnancy compared with those who develop it after pregnancies. The NP patients with SSc had onset of disease at an earlier age, more severe lung involvement, and higher rate of death due to SSc.
authors.affiliation: Division of Rheumatology, Department of Medicine, Thomas Jefferson University, Philadelphia, PA 19107-5541, USA. Carol.Artlett@mail.tju.edu
authors.forename: C M
authors.initials: CM
authors.lastname: Artlett
authors.forename: M
authors.initials: M
authors.lastname: Rasheed
authors.forename: K E
authors.initials: KE
authors.lastname: Russo-Stieglitz
authors.forename: H H B
authors.initials: HH
authors.lastname: Sawaya
authors.forename: S A
authors.initials: SA
authors.lastname: Jimenez
mesh_terms: D000328:Adult; D017668:Age of Onset; D000368:Aged; D000974:Antibodies, Antinuclear / Q000032:analysis; D002423:Cause of Death; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D008875:Middle Aged; D011247:Pregnancy / Q000276:immunology / Q000706:statistics & numerical data*; D017584:Reproductive History; D012595:Scleroderma, Systemic / Q000276:immunology / Q000401:mortality*
chemical_list: D000974:Antibodies, Antinuclear