Barilaro Giuseppe, Castellanos Aleida, Gomez-Ferreira Inês, Lledó Gema Maria, Della Rocca Carlo, Fernandez-Blanco Lorena, Cervera Ricard, Baños Núria, Figueras Francesc, Espinosa Gerard
Department of Autoimmune Diseases, Hospital Clinic, Universitat de Barcelona, Villarroel, 08036, Barcelona, Catalonia, Spain.
Department of Maternal-Fetal Medicine, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Sant Joan de Déu and Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain.
Arthritis Res Ther. 2022 Apr 27;24(1):91. doi: 10.1186/s13075-022-02783-0.
Pregnancy in systemic sclerosis (SSc) patients is no more an infrequent event as it used to be, but literature data on pregnancy outcomes in women with SSc are scarce. The rate of preterm deliveries and intrauterine growth restriction (IUGR) seems to be increased, while the risk of miscarriages is controversial. Moreover, no study compared pregnancy outcomes in SSc with antiphospholipid syndrome (APS) and systemic lupus erythematosus (SLE). We performed a retrospective study to compare the pregnancy and disease outcomes of women with SSc with a cohort of age-matched women with systemic lupus erythematosus (SLE), antiphospholipid syndrome (APS), and healthy controls (HC).
A total of 154 pregnancies from SSc, SLE, APS patients, and HC were prospectively followed at the High-Risk Pregnancy Unit of our center from 2008 to 2019. The primary outcome was a composite endpoint of miscarriages, fetal deaths, intrauterine growth restriction (IUGR), preeclampsia, neonatal deaths, preterm birth, and small-for-gestational-age (SGA) newborns. Single adverse pregnancy outcomes (APO) represented secondary endpoints. SSc activity variations in relation to pregnancy were assessed.
The risk of APO was significantly higher in SSc patients compared to HC (60.6% vs 10.0%; OR = 14.42; 95% CI 3.70-56.18, p = 0.001) and SLE patients (60.6% vs 37.5%; OR = 3.56; 95% CI 1.29-9.83, p = 0.014). Compared to HC, women with SSc had an increased frequency of first trimester miscarriage (15% vs 0 %; p = 0.016), preeclampsia (12% vs 0%, p = 0.038), and SGA newborns (21.2% vs 0%; p = 0.003). Preterm deliveries were more frequent in SSc pregnancies in comparison with HC (24.2% vs 5%; OR = 6.08; 95% CI 1.19-31.02, p = 0.036) and SLE patients (24.2% vs 7.5%, OR = 5.68; 95% CI 1.1-29.38, p = 0.038). Disease remained stable in all SSc patients during pregnancy and up to 1 year after delivery.
We found an increased risk of APO in our SSc cohort in comparison with HC (with higher rates of miscarriages, preeclampsia, SGA newborns, and preterm deliveries) and SLE patients (presenting a higher rate of preterm deliveries). High-risk multidisciplinary management of SSc pregnant women is highly recommended.
系统性硬化症（SSc）患者怀孕已不再像过去那样罕见，但关于SSc女性妊娠结局的文献资料匮乏。早产和胎儿宫内生长受限（IUGR）的发生率似乎有所增加，而流产风险存在争议。此外，尚无研究比较SSc与抗磷脂综合征（APS）和系统性红斑狼疮（SLE）患者的妊娠结局。我们进行了一项回顾性研究，以比较SSc女性与年龄匹配的系统性红斑狼疮（SLE）、抗磷脂综合征（APS）女性队列及健康对照（HC）的妊娠和疾病结局。
2008年至2019年，我们中心的高危妊娠单元对154例来自SSc、SLE、APS患者及HC的妊娠进行了前瞻性随访。主要结局是流产、胎儿死亡、胎儿宫内生长受限（IUGR）、先兆子痫、新生儿死亡、早产和小于胎龄（SGA）新生儿的复合终点。单一不良妊娠结局（APO）为次要终点。评估了与妊娠相关的SSc活动变化。
与HC相比，SSc患者发生APO的风险显著更高（60.6%对10.0%；OR = 14.42；95%CI 3.70 - 56.18，p = 0.001），与SLE患者相比也更高（60.6%对37.5%；OR = 3.56；95%CI 1.29 - 9.83，p = 0.014）。与HC相比，SSc女性早期流产（15%对0%；p = 0.016）、先兆子痫（12%对0%，p = 0.038）和SGA新生儿（21.2%对0%；p = 0.003）的发生率更高。与HC相比，SSc妊娠早产更频繁（24.2%对5%；OR = 6.08；95%CI 1.19 - 31.02，p = 0.036），与SLE患者相比也更频繁（24.2%对7.5%，OR = 5.68；95%CI 1.1 - 29.38，p = 0.038）。所有SSc患者在孕期及产后1年内疾病保持稳定。
我们发现，与HC相比（流产、先兆子痫、SGA新生儿和早产发生率更高）以及与SLE患者相比（早产发生率更高），我们的SSc队列中APO风险增加。强烈建议对SSc孕妇进行高危多学科管理。
