Background/Purpose:

Patients with different autoimmune rheumatic diseases are subject to different pregnancy outcomes because of deviant immunity. Systemic sclerosis is known to be associated with higher risk of poor maternal and fetal-neonatal outcomes, such as scleroderma renal crisis and cardiopulmonary complications. The number of pregnancies in patients with systemic sclerosis are relatively lower than other autoimmune diseases such as systemic lupus erythematosus, ankylosing spondylitis or rheumatoid arthritis in Taiwan. The risks and severity of adverse maternal and neonatal outcomes in systemic sclerosis patients are yet to be documented. This study was designed to analyze the risk of adverse fetal-neonatal and maternal in pregnancies in women with systemic sclerosis in Taiwan.

Methods:

We identified 2338180 singleton pregnancies using the birth registry and National Health Insurance Research Database (NHIRD) of Taiwan from 2001 through 2012. 12159 pregnant women suffered from a autoimmune rheumatic diseases and 60 were systemic sclerosis. We verified adverse maternal outcomes as death, acute myocardial infarction, acute renal injury, acute respiratory distress syndrome, eclampsia, pulmonary hypertension, sepsis, shock, thrombotic embolism and cerebrovascular disorders. Fetal-neonatal adverse outcomes are verified as stillbirth, low birth weight, low 1 and 5 min APGAR score and fetal distress.

To estimate odds ratios (ORs) and 95% confidence intervals (CIs) for pregnancy outcomes we used an adjusted generalized estimating equation model.

Results:

Pregnancy in 60 women with systemic sclerosis were associated with operation on heart and pericardium (OR 24.78 (6.19-99.2)), puerperal cerebrovascular diseases (OR 12.3 (1.73-87.40)), preterm labor (OR 2.43 (1.27-4.68)) and preeclampsia (OR 1.94 (0.62-6.01)). Offspring of women with systemic sclerosis were associated with low birthweight (OR of 2.46 (1.40-4.32)), fetal distress (OR 2.49 (1.25-4.95)), low 1-minute Apgar scores (OR 1.93 (0.62-5.97)) and 5-minute Apgar scores (OR 5.68 (1.45-22.3)). Risks for pregnancy related hypertension (OR 3.06), antepartum hemorrhage (OR 1.52), severe postpartum hemorrhage, and severe postpartum hemorrhage (OR 1.53) were higher in pregnant women with systemic sclerosis. Both maternal and fetal-neonatal outcomes were poor in systemic sclerosis women.

Conclusion:

Women with systemic sclerosis were prone to have a higher risk for adverse maternal and neonatal outcomes especially cerebrovascular events and lower APGAR score. Planned pregnancy and rigorous monitoring of renal function ,blood pressure and signs and symptoms of cerebrovascular diseases are recommended in women with systemic sclerosis.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/risk-and-severity-of-adverse-pregnancy-outcomes-in-women-with-systemic-sclerosis-in-taiwan/