Systemic Sclerosis and Pregnancy: Risks & Effects
Table of Contents
Women diagnosed with systemic sclerosis (SSc), also known as scleroderma, face a significantly elevated risk of adverse pregnancy outcomes, according to a comprehensive Swedish national health register study. The findings underscore the critical need for specialized, multidisciplinary maternal care and proactive pre-pregnancy counseling for these individuals, especially for those experiencing their first pregnancy.
Understanding the Risks: A Swedish Cohort Study
A large-scale, population-based cohort study, drawing data from Swedish national health registers between 1987 and 2021, meticulously assessed pregnancy outcomes in women with and without SSc. The research, led by Weng lan Che, PhD, from the Clinical Epidemiology Division at Karolinska Institutet in Stockholm, Sweden, aimed to shed light on the complexities of pregnancy in the context of this autoimmune condition.
The study identified 972 pregnancies in women with SSc, categorizing them based on their timing relative to the SSc diagnosis: pregnancies occurring after diagnosis, and those occurring before diagnosis. Pregnancies before diagnosis where further refined into those occurring 0-3 years prior to diagnosis and those occurring more than 3 years before diagnosis. These pregnancies were than carefully matched with comparator pregnancies in women without SSc from the general population.
Key Findings: Elevated Risks Across Multiple outcomes
The analysis revealed a concerning pattern of increased risks for several adverse pregnancy outcomes among women with SSc.
Post-Diagnosis Pregnancies: Women with SSc experiencing pregnancies after their diagnosis faced substantially higher risks. This included a nearly fourfold increased risk for preeclampsia (adjusted relative risk [aRR] 3.8; 95% CI, 1.8-7.8), a more than threefold increased risk for preterm birth (aRR, 3.3; 95% CI, 1.8-6.1), and a 2.5-fold increased risk for cesarean delivery (aRR, 2.5; 95% CI, 1.8-3.5).
Primiparous Women: The risks were particularly pronounced for women with SSc having their first child (primiparous women). These individuals exhibited a striking 7.5-fold increased risk for preeclampsia and a 5.1-fold increased risk for preterm birth, highlighting a critical vulnerability during their initial pregnancy journey.
* Pregnancies Before Diagnosis: Even pregnancies occurring before a formal SSc diagnosis were associated with heightened risks.Pregnancies within the 0-3 year window preceding diagnosis showed increased odds of preterm birth (adjusted odds ratio [aOR] 3.6; 95% CI, 1.2-10.6) and a more than fourfold increased odds of having a small-for-gestational-age (SGA) birth (10th percentile; aOR, 4.1; 95% CI, 1.7-10.1). Furthermore, pregnancies occurring more than three years before diagnosis still demonstrated increased odds of preeclampsia (aOR, 1.9; 95% CI,1.1-3.1) and preterm birth (aOR, 1.6; 95% CI, 1.0-2.4), suggesting that the underlying disease processes may be impacting pregnancies even before clinical recognition.
Implications for Clinical Practice
The study’s authors emphasize that these findings necessitate a paradigm shift in how pregnancy is managed for women with SSc. “Our observations highlight the need for multidisciplinary maternal care and pre-pregnancy counseling also for today’s women with SSc, with a special focus on primiparous women for [whom] the risks are the highest,” they stated.
This means that a collaborative approach involving rheumatologists, obstetricians, maternal-fetal medicine specialists, and other healthcare professionals is paramount. Pre-pregnancy counseling should involve a thorough assessment of the woman’s health status, potential risks, and strategies for optimizing outcomes. Close monitoring throughout pregnancy, with a keen eye for early signs of complications like preeclampsia and preterm labor, is essential.
Limitations and Future Directions
While this study provides invaluable insights, it’s important to acknowledge its limitations. As a register-based study, it did not have access to crucial information regarding disease activity, specific serologic patterns (e.g., antibody types), or the treatments patients were