Special considerations in pregnant systemic sclerosis patients

Sobanski, Vincent; Launay, David; Depret, S.; Ducloy-Bouthors, A.-S.; Hachulla, É.

doi:10.1080/1744666x.2016.1194201

Cited by 22 publications

(12 citation statements)

References 48 publications

(63 reference statements)

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“…There are a number of review articles on pregnancies in autoimmune connective tissue diseases, but few of them specifically addressed pregnancies involving SSc 3,12,14,15,17,[20][21][22][23][24][25][26] . None were systematic literature reviews, and several were done more than 20 years ago when diagnostic criteria were not as uniform 14,20,21,22,23 and the number of studies available for review were even fewer than today.…”

Section: Discussionmentioning

confidence: 99%

“…Still, SSc is considered a condition causing increased risk of pregnancy complications and maternal and fetal morbidity. In particular, higher risk for obstetric complications has been seen in patients with early diffuse cutaneous SSc (< 4 yrs of disease duration) 7 , those who are antitopoisomerase I or anti-RNA polymerase III-positive 16,17 , and those using corticosteroids 10 . To date, no clear predictors of adverse fetal and maternal outcome have been identified.…”

mentioning

confidence: 99%

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Pregnancy in Systemic Sclerosis: Results of a Systematic Review and Metaanalysis

Blagojević

Alodhaibi²,

Aly³

et al. 2019

J Rheumatol

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Objective.Through a systematic literature search (SLR) and metaanalysis, to determine maternal and fetal outcomes in pregnancies involving systemic sclerosis (SSc), to analyze the effect of pregnancy on disease activity, and to examine predictors of fetal and maternal outcomes.Methods.An SLR was performed for articles on SSc and pregnancy published between 1950 and February 1, 2018. Reviewers double-extracted articles to obtain agreement on > 95% of predefined critical outcomes.Results.Out of 461 publications identified, 16 were included in the metaanalysis. The metaanalysis showed that pregnancies involving SSc were at higher risk of miscarriage (OR 1.6, 95% CI 1.22–2.22), fetuses with intrauterine growth retardation (IUGR; OR 3.2, 95% CI 2.21–4.53), preterm births (OR 2.4, 95% CI 1.14–4.86), and newborns with low birth weight (OR 3.8, 95% CI 2.16–6.56). Patients with SSc had a 2.8 times higher chance of developing gestational hypertension (HTN; OR 2.8, 95% CI 2.28–3.39) and a 2.3 times higher chance of cesarean delivery compared to controls (OR 2.3, 95% CI 1.37–3.8). The definitions of disease worsening/new visceral organ involvement were too inexact to have any confidence in the results, although worsening or new disease manifestations during pregnancy in 44/307 cases (14.3%) and 6 months postpartum in 32/306 cases (10.5%) were reported. The data did not permit definition of predictors of disease progression and of maternal and fetal outcomes.Conclusion.Pregnancies involving SSc have increased frequency of miscarriages, IUGR, preterm deliveries, and newborns with low birth weight compared to healthy controls. Women with SSc were more prone to develop gestational HTN and to undergo cesarean delivery. Disease manifestations seem to remain stable or improve in most patients.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Pregnancy in Systemic Sclerosis: Results of a Systematic Review and Metaanalysis

Blagojević

Alodhaibi²,

Aly³

et al. 2019

J Rheumatol

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“…Similar considerations may apply to systemic sclerosis (SS), a severe immunologic disease mostly affecting women of postmenopausal age, but present also in a younger population, where it carries a risk for prematurity and IUGR and SGA babies. Conversely, SS flares are rare but may be life-threatening in pregnancy [ 81 , 82 , 83 , 84 ].…”

Section: Chronic Kidney Diseasementioning

confidence: 99%

Pregnancy in Chronic Kidney Disease: Need for Higher Awareness. A Pragmatic Review Focused on What Could Be Improved in the Different CKD Stages and Phases

Piccoli

Zakharova

Attini

et al. 2018

JCM

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Pregnancy is possible in all phases of chronic kidney disease (CKD), but its management may be difficult and the outcomes are not the same as in the overall population. The prevalence of CKD in pregnancy is estimated at about 3%, as high as that of pre-eclampsia (PE), a better-acknowledged risk for adverse pregnancy outcomes. When CKD is known, pregnancy should be considered as high risk and followed accordingly; furthermore, since CKD is often asymptomatic, pregnant women should be screened for the presence of CKD, allowing better management of pregnancy, and timely treatment after pregnancy. The differential diagnosis between CKD and PE is sometimes difficult, but making it may be important for pregnancy management. Pregnancy is possible, even if at high risk for complications, including preterm delivery and intrauterine growth restriction, superimposed PE, and pregnancy-induced hypertension. Results in all phases are strictly dependent upon the socio-sanitary system and the availability of renal and obstetric care and, especially for preterm children, of intensive care units. Women on dialysis should be aware of the possibility of conceiving and having a successful pregnancy, and intensive dialysis (up to daily, long-hours dialysis) is the clinical choice allowing the best results. Such a choice may, however, need adaptation where access to dialysis is limited or distances are prohibitive. After kidney transplantation, pregnancies should be followed up with great attention, to minimize the risks for mother, child, and for the graft. A research agenda supporting international comparisons is highly needed to ameliorate or provide knowledge on specific kidney diseases and to develop context-adapted treatment strategies to improve pregnancy outcomes in CKD women.

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“…The following variables were collected at each follow-up visit during pregnancy in SSc patients: heart rate, blood pressure and signs or symptoms suggestive of organ or system involvement related to SSc such as Raynaud's phenomenon, digital ulcers and any other skin, articular, pulmonary, cardiac, renal, or gastrointestinal manifestation. Lung, heart, and kidney involvement were assessed from the clinical and laboratory point of view according to several authors [21,22]. In case of high clinical suspicion of clinical manifestations related to SSc, speci c tests such as pulmonary function test or Doppler echocardiogram were performed.…”

Section: Methodsmentioning

confidence: 99%

Systemic sclerosis and pregnancy outcomes: a retrospective study from a single centre

Barilaro

Gutierrez

Ferreira

et al. 2021

Preprint

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Background Pregnancy in systemic sclerosis (SSc) patients is no more an infrequent event as it used to be, but literature data on pregnancy outcomes in women with SSc are scarce. The rate of preterm deliveries and intrauterine growth restriction (IUGR) seems to be increased, while the risk of miscarriages is controversial. Moreover, no study compared pregnancy outcomes in SSc with antiphospholipid syndrome (APS) and systemic lupus erythematosus (SLE). We performed a retrospective study to compare the pregnancy and disease outcomes of women with SSc with a cohort of age-matched women with systemic lupus erythematosus (SLE), antiphospholipid syndrome (APS) and healthy controls (HC). Methods 154 pregnancies from SSc, SLE, APS patients and HC were prospectively followed at the High-Risk Pregnancy Unit of our center from 2008 to 2019. The primary outcome was a composite endpoint of miscarriages, fetal deaths, intrauterine growth restriction (IUGR), preeclampsia, neonatal deaths, preterm birth, and small-for-gestational-age (SGA) newborns. Single APO represented secondary endpoints. SSc activity variations in relation to pregnancy were assessed. Results The risk of APO was significantly higher in SSc patients compared to HC (60.6% vs 10.0%; OR = 14.42; 95% CI 3.70–56.18, p = 0.001) and SLE patients (60.6% vs 37.5%; OR = 3.56; 95% CI 1.29–9.83, p = 0.014). Compared to HC, women with SSc had an increased frequency of first trimester miscarriage (15% vs 0 %; p = 0.016), preeclampsia (12% vs 0%, p = 0.038), IUGR (15% vs 0%; p = 0.016), and SGA newborns (21.2% vs 0%; p = 0.003). Preterm deliveries were more frequent in SSc pregnancies in comparison to HC (24.2% vs 5%; OR = 6.08; 95% CI 1.19–31.02, p = 0.036) and SLE patients (24.2% vs 7.5%, OR = 5.68; 95% CI 1.1–29.38, p = 0.038). Disease remained stable in all SSc patients during pregnancy and up to one year after delivery. Conclusions We found an increased risk of APO in our SSc cohort in comparison to HC (with higher rates of miscarriages, preeclampsia, IUGR, SGA newborns and preterm deliveries) and SLE patients (presenting higher rate of preterm deliveries). High-risk multidisciplinary management of SSc pregnant women is highly recommended.

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Special considerations in pregnant systemic sclerosis patients

Cited by 22 publications

References 48 publications

Pregnancy in Systemic Sclerosis: Results of a Systematic Review and Metaanalysis

Pregnancy in Systemic Sclerosis: Results of a Systematic Review and Metaanalysis

Pregnancy in Chronic Kidney Disease: Need for Higher Awareness. A Pragmatic Review Focused on What Could Be Improved in the Different CKD Stages and Phases

Systemic sclerosis and pregnancy outcomes: a retrospective study from a single centre

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