INTERNATIONAL MULTICENTRIC PROSPECTIVE STUDY ON PREGNANCY IN SYSTEMIC SCLEROSIS (IMPRESS-2)
Authors: E. Tombetti et al.
Data about the obstetric outcomes of pregnant women with Systemic Sclerosis (SSc) mainly derive from retrospective studies. This study therefore assessed the obstetric, pediatric and rheumatologic outcomes of SSc pregnancies in a prospective controlled study by recruiting of three cohorts, namely 110 pregnant women with SSc, 218 control pregnancies without systemic autoimmune diseases and 78 non-pregnant control SSc.
Miscarriages and fetal death occurred in 7% and 5% of SSc pregnancies. Compared to control pregnancies, SSc pregnancies had higher rates of gestational hypertension (12% Vs 4%, p=0.004), pre-eclampsia (9% Vs 1%, p=0.002), fetal growth-restriction (13% Vs 4%, p=0.004), prematurity (26% Vs 7%, p<0.001) and cesarean section (52% Vs 4%, p=0.002). Newborns from SSc mothers weighted less (2773 Vs 3243g, p<0.001), were more frequently small for gestational age (18% Vs 12%, p=0.05) and required neonatal-intensive care unit more frequently (12% Vs 1%, p<0.001). Rates of newborn malformation/death, and one year-pediatric outcomes were similar.
Multivariate logistic regression for pre-eclampsia in SSc identified baseline arterial hypertension, immunosuppressive agents or iloprost, twin pregnancy and assisted conception as risk factors. Baseline calcium channel blockers were protective factors. Pregnant and non-pregnant SSc women had a similar disease course during the 21 months of follow-up, despite a lower use of immunosuppressive agents. Two scleroderma-renal-crises (SRC) occurred during pregnancy (one was a relapse of a previous SRC; the other occurred at week 33, and resolved after premature delivery of a SGA newborn and ACE-inhibitors, preventing differentiation from pre-eclampsia).
This study corroborates previous retrospective data by demonstrating that SSc pregnancies have generally a favorable obstetric/pediatric outcome, albeit at a higher risk of pre-eclampsia, fetal growth restriction, prematurity, delivery of small for gestational age newborn and requirement of neonatal-ICU. Scleroderma renal crisis during late pregnancy and pre-eclampsia are hard to distinguish but pregnancy does not impact on SSc course.