Background/Purpose: In a systematic literature review and meta-analysis, to determine maternal and fetal outcomes in pregnant SSc women and to analyse the effect of pregnancy on SSc disease activity.

Methods: A systematic literature search was performed in four different databases: PubMed, Cochran, EMBASE and Web of Science for articles published between 1950 and 1st February 2018. All articles reporting on SSc and pregnancy were analysed. Review articles were examined for further references. Reviewers double extracted articles (with a third reviewer resolving differences) to: (1) obtain agreement on> 95% of pre-defined critical outcomes (eg pregnancy outcome, fetal death etc) and >90% of the other variables; (2) maintain quality assurance; (3) screen and extract data. Descriptive analysis described the results. Comparisons of SSc pregnancies to healthy controls used a Chi-square test.

Results: 458 publications were identified. 16 studies met the inclusion criteria and were included in the meta-analysis 1,403 pregnancies in the SSc group were compared to 12,196,221 healthy control pregnancies. In SSc pregnancies, there were significantly more miscarriages (15.7% vs 11.3%, p=0.007), stillbirths, (4.5% vs 0.3%, p<0.001), preterm births (12.9% vs 3.9%, p<0.001) and fetuses with intra-uterine growth retardation (IUGR) (5.5% vs 1.7%, p<0.001), compared to controls. There were no differences (all p<0.05) in the percent infant deaths (2.5% vs 1.9%), infant malformations (2.2% vs 1.7%) and low birth weight neonates (11.8% vs 9.4%) between the two groups. In SSc, pre-eclampsia (4.4% vs 1.1, p<0.00) and gestational hypertension (17.8% vs 8.4%, <0.001) occurred more frequently, compared to controls. In additions, there were significantly more Caesarean deliveries in SSc pregnancies (39% vs 31%, p<0.001). No increases in maternal mortality or eclampsia rates were observed in SSc patients versus controls. Regarding the effect of pregnancy on SSc disease activity, one or more disease manifestations worsened or appeared during pregnancy in 44/307 (14.3%). In additional in 32/306 (10.5%) pregnancies, SSc manifestations worsened or appeared during the 6-months post-partum period. In two cases this worsening led to maternal death.

Conclusion: Despite our rigorous inclusion/exclusion criteria resulting in selecting only 16 articles out of 458 publications, and despite the limited data available, our SLR and meta-analysis in SSc pregnancies demonstrated an increased frequency of miscarriages, stillbirths, IUGR and pre-term labour versus healthy control pregnancies. SSc patients were more prone to develop pre-eclampsia and gestational hypertension, but not eclampsia. Notably, maternal mortality was not increased in SSc pregnancies, nor did pregnancy lead to worsening disease in most cases. Further analysis is planned to identify the predictors for adverse fetal and maternal outcomes and for disease progression in SSc pregnancies.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/pregnancy-in-systemic-sclerosis-ssc-a-systematic-review-and-meta-analysis/