Gynaecologic history in systemic sclerosis

The aim of the study was to analyse the gynaecologic history of 150 Brazili an patients with systemic sclerosis (SSc) by comparing the outcome of the p regnancies before and after disease onset and in the two clinical variants of SSc, as well as to assess the effects of the pregnancy on the progress o f the disease. A retrospective analysis was carried out of 150 female SSc p atients, more than 18 years old, who attended the outpatient clinic of the Unit of Rheumatology of the State University of Campinas. The patients were questioned about the number of pregnancies, deliveries (full-term infants, premature births and twins) and fetal deaths (spontaneous abortions and pe rinatal deaths). These data were subdivided into pregnancies before and aft er SSc onset. In those gestations started after disease onset the patients were questioned about the evolution of SSc during the pregnancy. The patien ts were also asked about dyspareunia and the age at menopause. Thirty-two p atients (21%) had never been pregnant, and only five of them were considere d infertile. One hundred and eighteen patients (79%) had a total of 406 pre gnancies, with an average of 3.4 per patient; there were 364 pregnancies be fore and 42 after SSc onset. There were 58 fetal deaths (14% of the pregnan cies), 50 of these occurring before and eight after disease onset; 55 were spontaneous abortions and the other three were perinatal deaths. The fertil ity rate was higher in the limited SSc (3.6) than in the diffuse SSc patien ts (3.1), although the percentage of fetal deaths and the evolution of SSc during the pregnancy were similar in the two clinical variants. In the preg nancies that occurred after the onset of SSc, the clinical course remained stable in 72% of the cases, worsened in 14% and improved in 14%. Dyspareuni a was mentioned by 49 patients (37% of those with an active sexual life). M enopause was reported by 72 patients, predominantly with limited SSc (61 pa tients). The fertility rate in the postmenopausal SSc patients was 3.9, sim ilar to that observed in general postmenopausal population in Brazil. The a nalysis of the gynaecologic history in this series of SSc patients showed n o increased risk in infertility or spontaneous abortions. The fertility rat e in the two SSc clinical variants was higher than that observed in the loc al global population. Most of the patients who became pregnant after the on set of SSc showed no signs of worsening during the course of the disease.