Risk for adverse pregnancy outcomes greater in systemic sclerosis than lupus

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The authors report no relevant financial disclosures.

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Pregnant patients with systemic sclerosis demonstrate a higher risk for adverse pregnancy outcomes, including preterm delivery, than those with lupus and healthy controls, according to data published in Arthritis Research & Therapy.

“Until now, even though the overall obstetric result reported in the literature was good, there is no uniformity among the different studies, with discordant findings of different adverse pregnancy outcomes,” Gerard Espinosa, MD, PhD, of the Hospital Clínic de Barcelona, told Healio.

Graphic showing adverse pregancy outcomes in patientys with scleroderma

Pregnant patients with SSc demonstrate a higher risk for adverse pregnancy outcomes, including preterm delivery, than those with SLE and healthy controls, according to data derived from Barilaro G, et al. Arthritis Res Ther. 2022;doi;10.1186/s13075-022-02783-0.

To examine the prevalence of adverse pregnancy outcomes in pregnant patients with SSc, compared with those with systemic lupus erythematosus or antiphospholipid syndrome, Espinosa and colleagues prospectively followed 154 pregnancies in healthy individuals as well as patients with SSc, SLE and APS.

Researchers identified 21 patients who became pregnant following the onset of SSc symptoms between 2008 and 2019. Comparator groups consisting of 26 pregnant patients with SLE and 31 pregnant patients with antiphospholipid syndrome in the same period were also selected and followed. Finally, a group of 40 pregnant patients were selected for the healthy control. Patients were followed throughout the pregnancy and for up to 1 year post-delivery.

During the observational period, the researchers assessed heart rate, blood pressure, signs of organ or system involvement attributable to SSc, and kidney involvement at each visit. When there was high suspicion of a specific disease manifestation, such as Raynaud’s syndrome, specific tests were performed for confirmation.

A composite of adverse pregnancy outcomes served as the study’s primary endpoint. These outcomes were defined as miscarriages, fetal death, neonatal death before hospital discharge, preeclampsia, preterm birth, intrauterine growth restrictions and small-for-gestational-age newborns.

According to the researchers, the risk for adverse pregnancy outcomes was significantly higher in patients with SSc, compared with patients in the healthy control group — 60.6% vs. 10% (OR = 14.42; 95% CI, 3.7-56.18). Patients with SSc also had a higher likelihood of adverse pregnancy outcomes compared with patients with SLE — 60.6% vs. 37.5% (OR = 3.56; 95% CI, 1.29-9.83).

Patients with SSc were more likely than healthy controls to have a first-trimester miscarriage — 15% vs. 0% (P = .016) — preeclampsia — 12% vs. 0% (P = .038) — and small-for-gestational-age newborns — 21.2% vs. 0% (P = .003). In addition, preterm deliveries were more common in patients with SSc, at 24.2%, compared with the healthy control cohort, at 5% (OR = 6.08; 95% CI, 1.19-31.02, and SLE cohort, at 7.5% (OR – 5.68; 95% CI, 1.1-29.38).

“Pregnant women with SSc present with an increased risk of APO in our SSc cohort in comparison with healthy controls (with higher rates of miscarriages, preeclampsia, SGA newborns, and preterm deliveries) and SLE patients,” Espinosa said. “In my opinion, the take home message is that a high-risk multidisciplinary management of SSc pregnant women is recommended and, although it was not an objective of our work, the pre-gestational assessment is mandatory.”

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