title: Vascular Complications of Systemic Sclerosis during Pregnancy.
abstract: Systemic sclerosis (SSc) is a chronic autoimmune disorder characterized by progressive fibrosis of the skin and visceral tissues as well as a noninflammatory vasculopathy. Vascular disease in systemic sclerosis is a major cause of morbidity and mortality among nonpregnant patients with SSc and is even a bigger concern in the pregnant SSc patient, as the underlying vasculopathy may prevent the required hemodynamic changes necessary to support a growing pregnancy. Vascular manifestations including scleroderma renal crisis and pulmonary arterial hypertension should be considered relative contraindications against pregnancy due to the high associations of both maternal and fetal morbidity and mortality. In contrast, Raynaud's phenomenon may actually improve somewhat during pregnancy. Women with SSc who are considering a pregnancy or discover they are pregnant require evaluation for the presence and extent of underlying vasculopathy. In the absence of significant visceral vasculopathy, most women with SSc can expect to have reasonable pregnancy outcomes.
authors.affiliation: Division of Immunology and Rheumatology, Stanford University School of Medicine, 1000 Welch Road, Suite 203, Palo Alto, CA 94304, USA.
authors.forename: Eliza F
authors.initials: EF
authors.lastname: Chakravarty
references.citation: Semin Perinatol. 2001 Jun;25(3):120-3
references.pmid: 11453606
references.citation: Respir Physiol Neurobiol. 2010 Mar 31;170(3):215-25
references.pmid: 20149901
references.citation: Hum Pathol. 1998 Dec;29(12):1524-30
references.pmid: 9865842
references.citation: Arthritis Rheum. 2003 Aug;48(8):2246-55
references.pmid: 12905479
references.citation: Ann Rheum Dis. 2010 Feb;69(2):458-61
references.pmid: 19336420
references.citation: J Hypertens. 2004 Jul;22(7):1235-42
references.pmid: 15201535
references.citation: Hum Pathol. 2009 Mar;40(3):332-40
references.pmid: 18973923
references.citation: Int J Obstet Anesth. 2009 Apr;18(2):156-64
references.pmid: 19223169
references.citation: Eur J Clin Invest. 1994 Jan;24(1):76-8
references.pmid: 8187812
references.citation: Eur Heart J. 2009 Feb;30(3):256-65
references.pmid: 19147605
references.citation: Arthritis Rheum. 1999 Apr;42(4):763-8
references.pmid: 10211892
references.citation: Lupus. 2006;15(9):595-9
references.pmid: 17080915
references.citation: Semin Perinatol. 2000 Feb;24(1):11-4
references.pmid: 10709851
references.citation: Am J Health Syst Pharm. 2007 Sep 15;64(18):1922-6
references.pmid: 17823103
references.citation: Clin Exp Rheumatol. 2008 Nov-Dec;26(6):979-81
references.pmid: 19210858
references.citation: Arthritis Rheum. 1990 Aug;33(8):1249-55
references.pmid: 2390127
references.citation: Obstet Gynecol. 2002 Mar;99(3):490-6
references.pmid: 11864679
references.citation: Arthritis Rheum. 1989 Feb;32(2):151-7
references.pmid: 2920051
references.citation: Rheumatology (Oxford). 2008 Jun;47 Suppl 3:iii16-8
references.pmid: 18504278
references.citation: Arthritis Rheum. 2009 Jun;60(6):1831-9
references.pmid: 19479881
references.citation: J Obstet Gynaecol Br Commonw. 1970 Dec;77(12):1109-12
references.pmid: 5493615
references.citation: Scand J Rheumatol. 2003;32(1):55-7
references.pmid: 12635948
references.citation: Obstet Gynecol. 1974 Sep;44(3):349-54
references.pmid: 4854110
references.citation: Int J Gynaecol Obstet. 2007 Dec;99(3):248-9
references.pmid: 17889873
references.citation: Cleve Clin Q. 1985 Summer;52(2):207-11
references.pmid: 4028421
references.citation: Arthritis Rheum. 2009 Mar 15;61(3):400-4
references.pmid: 19248123
references.citation: Br J Anaesth. 1985 Nov;57(11):1136-9
references.pmid: 4052305
references.citation: Obstet Gynecol Surv. 2000 Sep;55(9):574-81
references.pmid: 10975484
references.citation: N Engl J Med. 2006 Jun 8;354(23):2443-51
references.pmid: 16760444
references.citation: Chest. 2004 Feb;125(2):580-6
references.pmid: 14769741
references.citation: Obstet Gynecol. 2000 Dec;96(6):956-61
references.pmid: 11084185
references.citation: Intern Med J. 2009 Nov;39(11):766-70
references.pmid: 19912403
references.citation: Cardiology. 2010;115(3):205-8
references.pmid: 20173324
references.citation: Rheum Dis Clin North Am. 2007 May;33(2):345-58, vii
references.pmid: 17499711
references.citation: Obstet Gynecol. 2008 Apr;111(4):927-34
references.pmid: 18378753
references.citation: Arthritis Rheum. 2005 Jul;52(7):2125-32
references.pmid: 15986394