Fetal and maternal outcomes in systemic sclerosis and very early diagnosis of systemic sclerosis pregnancies, a national prospective study

Anne Murarasu¹, lauren beaudeau², Véronique Le Guern³, gaelle guettrot-Imbert³, claire cazalets⁴, cecile durant⁵, Cecile Yelnik⁶, Céline Roussin⁷, Marie-Charlotte Besse⁸, Emilie Berthoux⁹, Emmanuel Chatelus¹⁰, Eric Hachulla¹¹, Estibaliz LAZARO¹², Francois Maurier¹³, Gaelle leroux¹⁴, Grégory Pugnet¹⁵, Isabelle durieu¹⁶, Loic RAFFRAY¹⁷, Maelle Le Besnerais¹⁸, Mélanie roriz¹⁹, Odile SOUCHAUD-DEBOUVERIE²⁰, Patrick JEGO²¹, Pauline ORQUEVAUX²², Claire de Moreuil²³, Helene MAILLARD²⁴, Nathalie Morel²⁵, Anna Molto²⁶, Camille Le Ray²⁷, emmanuelle pannier²⁷, loic sentilhes²⁵, Luc Mouthon²⁸, Nathalie Costedoat-Chalumeau²⁹ and Benjamin Chaigne³⁰, ¹Tours University Hospital, Tours, France, ²Centre Hospitalier Ales Les Cevennes, Ales, France, ³Cochin hospital, Paris, France, ⁴Rennes Hospital, Rennes, France, ⁵Nantes University Hospital, Nantes, France, ⁶lille university, Lille, France, ⁷Centre Hospitalier Ouest Réunion, Saint Paul, France, ⁸Tours University Hospital, ³⁷⁰⁰⁰ tours, Ile-de-France, France, ⁹Internal Medicine, Saint Luc Saint Joseph Hospital, Lyon, France, ¹⁰Department of Rheumatology, University Hospital Strasbourg, France, Strasbourg, France, ¹¹University of Lille, LILLE, France, ¹²Bordeaux University Hospital, Pessac, France, ¹³HOPITAUX PRIVES DE METZ, Vaux / Frankreich, France, ¹⁴Pitié-Salpêtrière University Hospital, Paris, France, ¹⁵CHU Toulouse Rangueil Service de Medecine Interne et Immunologie Clinique, Toulouse, France, ¹⁶Lyon University Hospital, Lyon, France, ¹⁷Félix-Guyon University Hospital of La Réunion, Saint Denis, France, ¹⁸Rouen University Hospital, Rouen, France, ¹⁹Agen hospital, Agen, France, ²⁰Poitiers University Hospital, Poitiers, France, ²¹Rennes University Hospital, Rennes, France, ²²Reims University Hospital, Reims, France, ²³CHU DE BREST, BREST, France, ²⁴Lille University Hospital, Lille, France, ²⁵Bordeaux University Hospital, Bordeaux, France, ²⁶Assistance Publique Hôpitauxde Paris, Paris, France, ²⁷Cochin Port Royal University Hospital, Paris, France, ²⁸Hopital Cochin - Paris University, Paris, France, ²⁹Inserm DR Paris ⁵, Paris, France, ³⁰Cochin University Hospital, Paris, France

Meeting: ACR Convergence 2025

Keywords: pregnancy, Scleroderma, Systemic

Session Information

Date: Wednesday, October 29, 2025

Title: Abstracts: Systemic Sclerosis & Related Disorders – Clinical III (2651–2656)

Session Type: Abstract Session

Session Time: 10:30AM-10:45AM

Background/Purpose: Pregnancy in women with systemic sclerosis (SSc) is considered high-risk due to complications like scleroderma renal crisis and preeclampsia, related to vasculopathy. Prospective data on pregnancy outcomes in SSc are lacking. We aimed to describe adverse pregnancy outcomes (APOs), disease course, and associated factors in SSc pregnancies, and to compare APO rates to the general population.

Methods: We included all pregnancies in women with SSc (ACR/EULAR 2013 criteria) or very early SSc (VEDOSS) enrolled in the French prospective GR2 study (2014–2020). We analyzed pregnancies beyond 22 weeks for APOs: fetal demise, preterm delivery≤34 weeks, placental insufficiency complications (preeclampsia, HELLP, fetal growth restriction [FGR], placental abruption), and small for gestational age (SGA, < 10th percentile using AUDIPOG curves). Disease worsening was defined as the appearance or progression of vascular manifestations (cutaneous ulcers, pulmonary arterial hypertension, or renal crisis), interstitial lung disease, worsening of skin fibrosis, calcinosis, joint involvement, or gastrointestinal tract involvement (excluding gastroesophageal reflux disease). Adverse pregnancy outcome rates were compared to those of age-matched controls from the 2016 French perinatal survey.

Results: Fifty-eight pregnancies (52 women) were included: 16 diffuse SSc (27.5%), 34 limited (58.6%), and 8 VEDOSS (13.8%). None had prior pulmonary arterial hypertension or renal crisis. Among 53 pregnancies beyond 22 weeks, 14 (26.4%) had APOs: 2 preterm deliveries (3.8%), 12 placental complications (22.6%; 7 preeclampsia, 5 FGR), and 6 SGA (11.3%). Six women (11.3%) had severe postpartum hemorrhage. Rates of preeclampsia, preterm birth, birth weight < 2500g, and postpartum hemorrhage were significantly higher than in the general population (13.2% vs 3.0%, p=0.001; 13.2% vs 5.8%, p< 0.047; 21.1% vs 4.3%, p< 0.0001; 11.3% vs 1.4%, p< 0.0001). No factors were significantly associated with APO in univariate analysis.Disease worsened in 23 of 58 pregnancies (39.7%), mostly cutaneous vascular events, especially postpartum. Risk factors included absence of anti-centromere antibodies (OR=0.2 [0.1–0.8]), diffuse SSc (OR=3.7 [1.1–12.4]), and prior cutaneous vascular involvement (OR=3.7 [1.2–11.5]).

Conclusion: In this prospective cohort of 58 pregnancies in women with SSc or VEDOSS and no prior severe organ involvement, 91.4% resulted in live births. Despite a relatively low incidence of severe complications, SSc pregnancies were associated with significantly higher rates of APOs and severe postpartum hemorrhage compared to the general population. Disease progression occurred in nearly 40% of cases, particularly affecting skin vascular manifestations during the postpartum period, and was more frequent in women with diffuse cutaneous SSc, prior vascular involvement, and antibodies other than anti-centromere.

Disclosures: A. Murarasu: GlaxoSmithKlein(GSK), 12, supported by GSK, and Chugai for attending meetings; l. beaudeau: None; V. Le Guern: AstraZeneca, 12, attending meetings and travel., Bristol-Myers Squibb(BMS), 6, Novartis, 2; g. guettrot-Imbert: None; c. cazalets: None; c. durant: None; C. Yelnik: None; C. Roussin: None; M. Besse: None; E. Berthoux: None; E. Chatelus: None; E. Hachulla: AstraZeneca, 2, 6, Boehringer-Ingelheim, 2, CSL Behring, 5, GlaxoSmithKlein(GSK), 2, 5, 6, Johnson & Johnson, 2, 5, 6, Novartis, 2, 5, Pfizer, 5, Roche-Chugai, 5, Sanofi-Genzyme, 2, 5, Sobi, 5; E. LAZARO: None; F. Maurier: None; G. leroux: None; G. Pugnet: None; I. durieu: MYLAN, 12, ATTENDING MEETINGS; L. RAFFRAY: None; M. Le Besnerais: None; M. roriz: None; O. SOUCHAUD-DEBOUVERIE: None; P. JEGO: None; P. ORQUEVAUX: None; C. de Moreuil: Roche, 5; H. MAILLARD: None; N. Morel: None; A. Molto: AbbVie/Abbott, 2, 5, 6, BIOGEN, 2, 5, 6, Bristol-Myers Squibb(BMS), 2, 5, 6, Eli Lilly, 2, 5, 6, Galapagos, 2, 5, Janssen, 2, 5, 6, Merck/MSD, 2, 5, Novartis, 2, 5, 6, Pfizer, 2, 5, 6, UCB Pharma France, 1, 6; C. Le Ray: None; e. pannier: None; l. sentilhes: None; L. Mouthon: Boehringer-Ingelheim, 6, csl, 5, 6, lfb biotechnologies, 5, Roche, 5; N. Costedoat-Chalumeau: Bristol-Myers Squibb(BMS), 6, Roche, 5, UCB Pharma France, 5; B. Chaigne: None.

To cite this abstract in AMA style:

Murarasu A, beaudeau l, Le Guern V, guettrot-Imbert g, cazalets c, durant c, Yelnik C, Roussin C, Besse M, Berthoux E, Chatelus E, Hachulla E, LAZARO E, Maurier F, leroux G, Pugnet G, durieu I, RAFFRAY L, Le Besnerais M, roriz M, SOUCHAUD-DEBOUVERIE O, JEGO P, ORQUEVAUX P, de Moreuil C, MAILLARD H, Morel N, Molto A, Le Ray C, pannier e, sentilhes l, Mouthon L, Costedoat-Chalumeau N, Chaigne B. Fetal and maternal outcomes in systemic sclerosis and very early diagnosis of systemic sclerosis pregnancies, a national prospective study [abstract]. Arthritis Rheumatol. 2025; 77 (suppl 9). https://acrabstracts.org/abstract/fetal-and-maternal-outcomes-in-systemic-sclerosis-and-very-early-diagnosis-of-systemic-sclerosis-pregnancies-a-national-prospective-study/. Accessed .

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