Fertility and pregnancy outcome in women with systemic sclerosis

Objective. To determine fertility and pregnancy outcome in women with syste mic sclerosis (SSc; scleroderma) who had disease onset before age 45 years. Methods. All living women with scleroderma who had first been evaluated at the University of Pittsburgh Scleroderma Clinic after January 1, 1972 were sent a detailed self-administered questionnaire in 1986 specifically concer ning pregnancy outcomes and infertility. This group was compared with 2 rac e- and age-matched control groups, one comprising women with rheumatoid art hritis (RA) and one comprising healthy neighborhood women identified by ran dom-digit dialing. We determined the number, history, treatment, and outcom e of women who either had never been pregnant or had attempted to become pr egnant unsuccessfully for more than 1 year. We also obtained data regarding pregnancy outcomes, including the frequency of miscarriage, premature birt hs, small full-term infants, perinatal deaths, and births of live healthy i nfants. Results. The study group comprised 214 women with SSc, 167 with RA, and 105 neighborhood controls. There were no significant differences in the overal l rates of miscarriage, premature births, small full-term births, or neonat al deaths between the 3 groups. Women with SSc were more likely than those without SSc to have adverse outcomes of pregnancy after the onset of their rheumatic disease, particularly premature births (also seen in RA women aft er disease onset) and small full-term infants. Although a significantly gre ater number of women with SSc had never been pregnant, there were no signif icant differences in the frequency of never having been pregnant or of infe rtility in the 3 groups after adjustment for contributing factors. Conclusion. This study indicates that women with SSc have acceptable pregna ncy outcomes compared with those of women with other rheumatic disease and healthy neighborhood controls. Infertility was not a frequent problem. We b elieve that there are no excessive pregnancy risks to women with SSc or the ir infants. However, a well-timed pregnancy with careful obstetric monitori ng, will maximize the likelihood of a successful outcome.