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Review
. 2018 Feb;3(1):21-29.
doi: 10.1177/2397198317747440. Epub 2018 Apr 4.

Pregnancy in systemic sclerosis

Mauro Betelli  1 , Silvia Breda  2 , Veronique Ramoni  3 , Federico Parisi  2 , Stefania Rampello  4 , Massimiliano Limonta  5 , Marianna Meroni  6 , Antonio Brucato  2
Affiliations
Review

Pregnancy in systemic sclerosis

Mauro Betelli et al. J Scleroderma Relat Disord. 2018 Feb.

Abstract

This comprehensive review summarizes retrospective and prospective studies on pregnancy in systemic sclerosis in order to educate physicians on critical management issues. Fertility is normal in women with established systemic sclerosis. Their rates of spontaneous losses are comparable to the general population, except for patients with late diffuse systemic sclerosis and severe internal organ involvement who may have higher risks of abortion. Prematurity is clearly higher among systemic sclerosis women, similarly to other rheumatic diseases such as systemic lupus erythematosus and anti-phospholipid antibody syndrome. A placental vasculopathy has been observed in some women with systemic sclerosis. Overall, the disease generally remains stable in most pregnancies. Women with pulmonary hypertension should avoid pregnancy on account of the high maternal mortality risk. Management of systemic sclerosis patients before and during pregnancy includes evaluation of organ involvement and autoantibody analysis, preconceptional folic acid, and discontinuation of drugs with teratogenic potential (bosentan, mycophenolate mofetil, methotrexate, etc.). Management by high-risk pregnancy teams including neonatologists is very important to ensure the best outcomes.

Keywords: Pregnancy; Prematurity; Renal crisis; Scleroderma; Systemic sclerosis.

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Conflict of interest statement

Disclosures: Financial support: No grants or funding have been received for this study. Conflict of interest: None of the authors has financial interest related to this study to disclose.

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