Silman A J
ARC Epidemiology Research Unit, University of Manchester, United Kingdom.
Am J Reprod Immunol. 1992 Oct-Dec;28(3-4):238-40. doi: 10.1111/j.1600-0897.1992.tb00802.x.
Scleroderma is a rare disease with a marked female excess in incidence. The pattern of age of onset, together with the effects of the disease, are such that the majority of women with scleroderma experience pregnancy prior to diagnosis. There are three questions of interest: (1) Does pregnancy adversely affect the prognosis of scleroderma? Isolated case reports suggest that renal disease, and in particular hypertensive crises, are associated with pregnancy in the absence of any renal abnormality before pregnancy. However, such events are rare. (2) Does scleroderma adversely affect either fertility or the outcome of pregnancy? Women with established scleroderma, again in case series, have a high rate of spontaneous miscarriage which is not found consistently in epidemiological studies. Prematurity and low birth rates are more frequent problems. (3) Does reproductive history influence disease and particularly Raynaud's phenomenon may antedate diagnosis by many years and might influence reproductive outcome, in general reproductive outcome is similar to that seen after diagnosis, although fertility appears to be reduced.
硬皮病是一种罕见疾病，发病率女性明显高于男性。发病年龄模式以及该疾病的影响使得大多数硬皮病女性在诊断前经历过妊娠。有三个值得关注的问题：（1）妊娠是否会对硬皮病的预后产生不利影响？个别病例报告表明，肾脏疾病，尤其是高血压危象，与妊娠相关，而妊娠前并无任何肾脏异常。然而，此类事件很少见。（2）硬皮病是否会对生育能力或妊娠结局产生不利影响？在病例系列中，已确诊硬皮病的女性自然流产率较高，但在流行病学研究中并未一致发现这一情况。早产和低出生率是更常见的问题。（3）生育史是否会影响疾病，尤其是雷诺现象可能在诊断前数年就已出现，并可能影响生殖结局，总体而言，生殖结局与诊断后相似，尽管生育能力似乎有所下降。
