[2009] [FRI0341] PREGNANCY IN SYSTEMIC SCLEROSIS: A PROSPECTIVE STUDY
M. Taraborelli1, P. Airò1, M. Nuzzo1, S. De Leone2, S. Zingarelli1, M. Scarsi1, R. Cattaneo1, A. Lojacono2, A. Tincani1 1Rheumatology and Clinical Immunology; 2Obstetrics and Gynecology, Spedali Civili and University, Brescia, Italy
Background: For many years pregnancy in Systemic Sclerosis (SSc) has been considered at high risk both for mothers and children. Nowadays there are encouraging data about successful pregnancies, even if a high frequency of complications has been reported by some authors.
Objectives: To assess the course, outcome and effects of pregnancy on disease in SSc patients.
Methods: We conducted a prospective study from 2001 to 2008 following 316 SSc Italians patients (40 women of childbearing age). Pregnant patients were subjected to physical, laboratory and instrumental examinations by a team of rheumatologists and gynecologists in preconceptional period, monthly during pregnancy and after delivery.
Results: Ten pregnancies occurred in 7 women. Only one of them had had previous pregnancies. Three had limited SSc (lSSc) and 4 diffuse SSc (dSSc). Anti-topo I antibodies were positive in 3 patients, anticentromere in 1, anti-U1RNP in 1, anticardiolipin (low-titre IgG)in 1, anti-beta2-glycoprotein-I (B2GPI low-titre IgG) in 1. Anti-RNApolymeraseIII, antiRo/SSA and lupus anticoagulant were negative in all patients. In all cases the disease was inactive according to the Valentini Disease Activity Index. SSc organ disease severity, according to Medsger indexes, was absent or mild, except for skin (moderate in 2 patients), gastrointestinal (moderate in 1) and lung (moderate in 1). The average age at conception was 30.1 years (±2.5 SD) and the disease duration 67 months (±41 SD). Patients received cardioaspirin in 100% of cases during pregnancy, folic acid in 80%, calcium-channel blockers in 40% and corticosteroids in 30%. One of the dSSc patients (not taking folic acid, without antiphospholipid antibodies) experienced a spontaneous miscarriage at 7th week. The other 9 pregnancies concluded with full term babies (one, from a lSSc mother, was small for gestational age). Seven deliveries were vaginal (6 spontaneous, 1 induced for premature rupture of the membranes); in 2 cases a cesarean section was performed (1 planned, 1 for fetal suffering in a woman with lSSc and anti-B2GPI). One of the babies was born with an omphalocele and, like his father, with a monolateral renal agenesis. We did not observe cases of hypertension, renal crisis or pre-eclampsia. During pregnancy in 77% of cases women experienced an improvement of Raynaud's phenomenon from the first or second trimester. In one case Rodnan Skin Score significantly improved (>30%) during this period, but in 2 cases it was significantly higher after delivery. Palpitations occurred in 44% of women, dyspnea worsened in 55%, esophageal symptoms in 100%, constipation in 44%. All these alterations were reversible after delivery. Only in one woman carbon monoxide lung diffusion capacity was significantly reduced after pregnancy (from 91% to 71%). Articular, tendineous or muscular involvement did not modify during pregnancy.
Conclusion: Our experience shows that SSc patients with a stable disease, an adequate monitoring and a careful therapy management, can have successful pregnancies. In our series only sporadic complications occurred and some women had more than one pregnancy. Even if some disease symptoms seem to intensify during pregnancy, they probably are physiologic consequences of being pregnant, as suggested by ready disappearance after delivery.
Disclosure of Interest: None declared
Ann Rheum Dis 2009;68(Suppl3):468
Scleroderma, myositis and related syndromes
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