Brief report: successful pregnancies but a higher risk of preterm births in patients with systemic sclerosis: an Italian multicenter study.
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.


CONCLUSIONS
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.
Spedali Civili and Università degli Studi di Brescia, Brescia, Italy.
Mara
M
Taraborelli
Véronique
V
Ramoni
Antonio
A
Brucato
Paolo
P
Airò
Gianluigi
G
Bajocchi
Francesca
F
Bellisai
Domenico
D
Biasi
Jelena
J
Blagojevic
Valentina
V
Canti
Roberto
R
Caporali
Paola
P
Caramaschi
Ilaria
I
Chiarolanza
Veronica
V
Codullo
Franco
F
Cozzi
Giovanna
G
Cuomo
Maurizio
M
Cutolo
Maria
M
De Santis
Salvatore
S
De Vita
Emma
E
Di Poi
Andrea
A
Doria
Paola
P
Faggioli
Maria
M
Favaro
Gianfranco
G
Ferraccioli
Clodoveo
C
Ferri
Rosario
R
Foti
Alessandro
A
Gerosa
Maria
M
Gerosa
Sarah
S
Giacuzzo
Leopoldo
L
Giani
Dilia
D
Giuggioli
Massimo
M
Imazio
Michele
M
Iudici
Annamaria
A
Iuliano
Roberto
R
Leonardi
Massimiliano
M
Limonta
Andrea
A
Lojacono
Chiara
C
Lubatti
Marco
M
Matucci-Cerinic
Antonino
A
Mazzone
Marianna
M
Meroni
Pier Luigi
PL
Meroni
Marta
M
Mosca
Mario
M
Motta
Marina
M
Muscarà
Simona
S
Nava
Melissa
M
Padovan
Giorgio
G
Pagani
Giuseppe
G
Paolazzi
Susanna
S
Peccatori
Viviana
V
Ravagnani
Valeria
V
Riccieri
Edoardo
E
Rosato
Patrizia
P
Rovere-Querini
Felice
F
Salsano
Alessandro
A
Santaniello
Raffaella
R
Scorza
Chiara
C
Tani
Gabriele
G
Valentini
Guido
G
Valesini
Massimo
M
Vanoli
Barbara
B
Vigone
Silvana
S
Zeni
Angela
A
Tincani
D000328:Adult; D005260:Female; D005317:Fetal Growth Retardation / Q000453:epidemiology*; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000453:epidemiology*; D015995:Prevalence; D012189:Retrospective Studies; D012306:Risk; D012595:Scleroderma, Systemic / Q000503:physiopathology*