Deshauer Siobhan, Junek Mats, Baron Murray, Beattie Karen A, Larché Margaret J
Division of Rheumatology, Department of Medicine, McMaster University, Hamilton, ON, Canada.
Division of Rheumatology, Jewish General Hospital, Department of Medicine, McGill University, Québec, QC, Canada.
J Scleroderma Relat Disord. 2023 Feb;8(1):27-30. doi: 10.1177/23971983221101311. Epub 2022 Jun 19.
To explore the trajectory of scleroderma disease activity in women who experienced a pregnancy after systemic sclerosis diagnosis compared to nulliparous women.
We analyzed data from the Canadian Scleroderma Research Group registry by identifying nulliparous women and women with ⩾1 pregnancy after systemic sclerosis diagnosis. Patient characteristics were compared between groups at registry entry. Controlling for age, smoking, and time since systemic sclerosis diagnosis, generalized estimating equations tested the effect of pregnancy on force vital capacity, diffusing capacity of the lungs for carbon monoxide, right ventricular systolic pressure, glomerular filtration rate, antibody status, active digital ulcers, physician global assessment of activity, and severity over 9 years.
At registry entry, numbers of women in the nulliparous and pregnancy after systemic sclerosis diagnosis groups were 153 and 45, respectively. Corresponding numbers at 6 and 9 years were 48 and 21, and 18 and 9, respectively. The prevalence of anti-topoisomerase positivity was 18.3% in nulliparous and 12.5% in pregnancy after systemic sclerosis diagnosis. Baseline differences included mean (Standard deviation) age of diagnosis (nulliparous: 38.8 (14.0), pregnancy after systemic sclerosis diagnosis: 22.6 (6.8) years, < 0.001), disease duration (nulliparous: 9.6 (8.9), pregnancy after systemic sclerosis diagnosis: 21.9 (9.6) years; < 0.001), and inflammatory arthritis (nulliparous: 41 (28%), pregnancy after systemic sclerosis diagnosis: 22 (49%), = 0.009). There were no significant differences between groups in the change of any outcomes over time.
Results demonstrated that having ⩾1 pregnancy after systemic sclerosis diagnosis did not appear to significantly impact long-term renal, respiratory, or global function outcomes. While this offers a hopeful message to systemic sclerosis patients planning a pregnancy, physicians and patients should remain vigilant for potential post-partum complications.
探讨系统性硬化症诊断后怀孕的女性与未生育女性相比，硬皮病疾病活动的轨迹。
我们通过识别未生育女性和系统性硬化症诊断后怀孕≥1次的女性，分析了加拿大硬皮病研究组登记处的数据。在登记时比较两组患者的特征。在控制年龄、吸烟和系统性硬化症诊断后的时间后，广义估计方程测试了怀孕对用力肺活量、肺一氧化碳弥散量、右心室收缩压、肾小球滤过率、抗体状态、活动性指端溃疡、医生对活动的整体评估以及9年期间严重程度的影响。
登记时，未生育组和系统性硬化症诊断后怀孕组的女性人数分别为153人和45人。6年和9年时相应的人数分别为48人和21人，以及18人和9人。未生育组抗拓扑异构酶阳性率为18.3%，系统性硬化症诊断后怀孕组为12.5%。基线差异包括诊断时的平均（标准差）年龄（未生育组：38.8（14.0）岁，系统性硬化症诊断后怀孕组：22.6（6.8）岁，P<0.001）、疾病持续时间（未生育组：9.6（8.9）年，系统性硬化症诊断后怀孕组：21.9（9.6）年；P<0.001）和炎性关节炎（未生育组：41例（28%），系统性硬化症诊断后怀孕组：22例（49%），P=0.009）。两组之间任何结局随时间的变化均无显著差异。
结果表明，系统性硬化症诊断后怀孕≥1次似乎对长期肾脏、呼吸或整体功能结局没有显著影响。虽然这为计划怀孕的系统性硬化症患者带来了希望，但医生和患者仍应警惕潜在的产后并发症。
