A Scleroderma Patient Inquires About Pregnancy

Abstract

Pregnancy in systemic sclerosis (SSc) may be uneventful with both good maternal and good fetal outcomes, but careful evaluation before and close monitoring during pregnancy are necessary to optimize outcomes. Women with diffuse SSc are at a greater risk for developing serious cardiopulmonary and renal problems early in the disease, so they should be encouraged to delay pregnancy until the disease stabilizes. There are some suggestions that infertility and miscarriages may be increased in SSc, but these issues do not have as great an impact as in certain other rheumatic diseases, for example, systemic lupus erythematosus (SLE). The high risk of premature and small infants may be minimized with specialized obstetrical and neonatal care. Renal crisis is the only truly unique aspect of these pregnancies. Diffuse SSc patients, particularly early in the course of disease, should be monitored very closely for renal crisis. Other pregnancy problems may not be unique to SSc, but because SSc is a chronic illness, any complication carries higher risks for both mother and child. Careful planning, close monitoring, and aggressive management should afford SSc patients a high likelihood of having a successful pregnancy.