[2008] [FRI0267] PREGNANCY OUTCOME IN EGYPTIAN SCLERODERMA PATIENTS

H.E. El-Sherif, S.M. El-Desouky, A.A. Shahin Rheumatology and Rehabilitation, Kasr El-Ainie Hospital, Faculty of medicine, Cairo University, Cairo, Egypt

Background: Pregnancy has variable effects on both the scleroderma (SSc) mother and the fetus. There have been reports of infertility, miscarriage, premature birth and fetal death. However other publications have described successful pregnancy outcome, without serious maternal or fetal complications in women with scleroderma.
Objectives: The study addressed the pregnancy outcome of scleroderma (SSc) patients and its relation to disease outcome.
Methods: Sixty-nine Egyptian patients with SSc were included in the study. Reproductive history was taken, the age of menarch, the age at marriage, contraceptive use, the number of children and the outcome of pregnancy were reported. The conception since marriage, the spacing of children and the maternal age at each birth were computed. The disease manifestations for SSc patients were determined. The scleroderma patients were compared with a control group of 30 healthy females with no history of autoimmune disease and with similar age of marriage as regards the pregnancy number, children number and abortion number. They were also compared in terms of pregnancy and abortion rate which is equal to the pregnancy or abortion number/the reproductive period. Comparison was made between the two groups in terms of abortion and children outcome which are the abortion and children number/pregnancy number.
Results: Evaluation of 69 SSc patients was carried out. Most of the patients were of the diffuse type with only 9 cases of the limited type. The age at marriage and length of the reproductive life for the SSc and control groups were almost identical. The number of pregnancies was significantly higher with the SSc compared to the control, however the number of children was similar in the 2 groups. The number of abortions in the SSc group was significantly higher than that for the control. The SSc group had 286 pregnancies while the control 74 pregnancies. The proportion of healthy children amounted to 76.1% for SSc and 90.5% for the control. Abortions amounted to 40.6% of the SSc and 9.5% for the control. The number of premature children was higher with the SSc (4.3%) compared to the control however the numbers were small 6 with SSc and a single case with the control. Abortions were limited to the systemic group, and that was statistically significant (p=0.008). There was not a statistically significant difference in the abortion versus the non-abortion group as regards the general, skin, skeletal, GIT, cardiac or chest manifestations. Only the difference with myositis was of borderline significance. There was a delay in conception as well as higher spacing between the children in case of SSc patients compared to the control.
Conclusion: The subclinical vasculopathy occurring during and even before disease onset can explain the higher proportion of abortions, premature children and delay in conception of the SSc patients. There was no recall of small for gestational age in the babies born and therefore this important outcome of pregnancy was not reported indicating the importance of documentation of the birth weight. There is an association between myositis and reduced abortion which needs further investigation including the effect of the drugs used should be considered.

Ann Rheum Dis 2008;67(Suppl II):369

Scleroderma, Myositis and related syndromes