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 were retrospectively analyzed. In 25 Italian centers 99 SSc women were observed during 109 pregnancies (in 2000-2011) and compared to the general obstetrical population (GOP, 3939 deliveries). Maternal mean age at conception was 31.8 years (SD 5.3) and median disease duration was 60 months (range 2-193). RESULTS.: In SSc patients preterm deliveries (25% vs. 12%) and severe preterm deliveries (<34 weeks) (10% vs. 5%), intrauterine growth restriction (6% vs. 1%) and very-low-birth-weight babies (5% vs. 1%) were significantly more frequent than in the GOP. Multivariable analysis found that corticosteroid use was associated with preterm deliveries (OR 3.63, 95% CI 1.12-11.78), while the use of folic acid was protective (OR 0.30, 95% CI 0.10-0.91), as were antitopoisomerase antibodies (OR 0.26, 95% CI 0.08-0.85). The disease remained stable in most SSc patients, but there were four cases of progression within one year from delivery, all in antitopoisomerase-positive women, three of them with less than three years' disease duration. CONCLUSIONS.: SSc patients can have successful pregnancies, but they have a higher than normal risk of preterm delivery, intrauterine growth restriction and very-low-birth-weight babies. 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 cases with severe organ damage and postponed in women with SSc of recent onset, particularly if antitopoisomerase positive.