Pregnancy in women with systemic sclerosis

Objective: To determine pregnancy outcomes in women with systemic sclerosis . Methods: Women of childbearing age with systemic sclerosis seen at the Univ ersity of Pittsburgh between 1987 and 1996 were observed prospectively. Pre gnancy outcomes included abortion, miscarriage, preterm and term birth, and perinatal death. Complications of pregnancy and scleroderma were determine d during and after pregnancy. Results: Fifty-nine women with systemic sclerosis had 91 pregnancies during the 10-year period. No increase in the frequency of miscarriage was found, except in those with long-standing diffuse scleroderma. Preterm births occ urred in 29% of pregnancies, and all but one of the infants survived. Sympt oms related to scleroderma, particularly Raynaud phenomenon, improved durin g pregnancy, but esophageal reflux became worse. After pregnancy, some wome n with diffuse scleroderma had increased skin thickening. There were three cases of renal crisis during pregnancy, all in women with early diffuse scl eroderma. Four women had five healthy infants while taking angiotensin-conv erting-enzyme inhibitors. Conclusion: Women with systemic sclerosis fan safely have healthy pregnanci es. Those with early diffuse scleroderma should wait until their disease st abilizes before becoming pregnant to decrease the risk of renal crisis. Hig h-risk pregnancy management should be standard for all scleroderma pregnanc ies because of the high frequency of premature births. (C) 1999 by The Amer ican College of Obstetricians and Gynecologists.