How Does Systemic Sclerosis Affect Pregnancy?

TOPLINE: 

Women with systemic sclerosis faced higher risks for adverse pregnancy outcomes such as preeclampsia and preterm birth in a Swedish cohort study. 

METHODOLOGY:

• A population-based cohort study based on data from Swedish national health registers from 1987 to 2021 assessed pregnancy outcomes in women with and without systemic sclerosis (SSc).
• Pregnancies were classified as those occurring before or after SSc diagnosis, with further classification as those occurring 0-3 years before diagnosis or more than 3 years before diagnosis.
• A total of 972 pregnancies in women with SSc (94 occurring after and 878 before diagnosis) were identified and matched with 1440 and 10,118 comparator pregnancies in women without SSc from the general population.
• Outcome measures included adverse pregnancy outcomes such as preeclampsia, gestational hypertension, preterm birth, and cesarean delivery.

TAKEAWAY:

• Postdiagnosis pregnancies showed increased risks for preeclampsia (adjusted relative risk [aRR], 3.8; 95% CI, 1.8-7.8), preterm birth (aRR, 3.3; 95% CI, 1.8-6.1), and cesarean delivery (aRR, 2.5; 95% CI, 1.8-3.5).
• Primiparous women with SSc had a 7.5-fold increased risk for preeclampsia and a 5.1-fold increased risk for preterm birth.
• Pregnancies within 0-3 years before SSc diagnosis showed increased odds of preterm birth (adjusted odds ratio [aOR], 3.6; 95% CI, 1.2-10.6) and small-for-gestational-age births (10th percentile; aOR, 4.1; 95% CI, 1.7-10.1).
• Pregnancies that occurred more than 3 years before SSc diagnosis showed increased odds of preeclampsia (aOR, 1.9; 95% CI, 1.1-3.1) and preterm birth (aOR, 1.6; 95% CI, 1.0-2.4).

IN PRACTICE:

“Our observations highlight the need for multidisciplinary maternal care and pre-pregnancy counseling also for today’s women with SSc, with a special focus on primiparous women for [whom] the risks are the highest,” the authors wrote.

SOURCE:

The study was led by Weng lan Che, PhD, Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet in Stockholm, Sweden. It was published online on July 8, 2025, in Arthritis & Rheumatology.

LIMITATIONS: 

This register-based study lacked information on disease activity, specific serologic patterns, and treatment. 

DISCLOSURES:

This study was supported by the Dr Margaretha Nilsson Foundation, the Swedish Research Council, and the Swedish Cancer Foundation. One author declared being a member of the medical advisory board of the Myositis Association, and another declared part-time employment at the Swedish Medical Products Agency.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.