Background/Purpose: There is limited guidance for women with systemic sclerosis (SSc) in making decisions about pregnancy and informing them about their disease post-partum. Peripartum maternal and fetal complications have been reported, yet little is known about disease activity after pregnancy. We explored the trajectory of disease activity in women who experienced a pregnancy after scleroderma diagnosis and compared it with women who were nulliparous (NP).

Methods: We conducted a retrospective cohort study using data from a national SSc database. We identified two groups of women: those who were NP and those who experienced ≥ one pregnancy after their diagnosis (PAD) of scleroderma. Women with pre-pregnancy cardiac, lung or renal disease were excluded. Of these patients, 97% met ACR classification criteria. Descriptive statistics at the time of entry into the CSRG for each group are shown in Table 1. T-tests compared differences between groups. We used generalized estimating equations to test for the effect of pregnancy on the following outcomes over 8 years: force vital capacity, diffusing capacity of the lungs for carbon monoxide, right ventricular systolic pressure, glomerular filtration rate, antibody-status, active digital ulcers, physician global assessment of activity and physician global assessment of severity. We controlled for age, smoking and time since SSc diagnosis.

Results: At entry into CSRG there were 153 women in the NP group and 45 in the PAD group. After 6 years, n=48 in NP and n=21 in PAD decreased to 18 and 9 patients after 9 years, respectively. Prevalence of anti-topoisomerase positivity was 18.3% in NP and 12.5% in PAD. Differences in baseline characteristics included age of diagnosis (NP 38.8 years, SD 14; PAD 22.6, SD 6.8; p< 0.001), duration of disease (NP 9.6 years, SD 8.9; PAD 21.9, SD 9.6; p< 0.001) and inflammatory arthritis reported by rheumatologists (NP 41, 28%; PAD 22, 49%, p=0.009). Arthritis was not assessed over time.

There were no statistical differences between groups in the change of force vital capacity, diffusing capacity of the lungs for carbon monoxide, right ventricular systolic pressure, glomerular filtration rate, antibody-status, active digital ulcers, physician global assessment of activity and physician global assessment of severity over time.

Conclusion: This retrospective cohort study demonstrated that having ≥1 pregnancy after a diagnosis of systemic sclerosis did not appear to significantly impact renal, respiratory or global function outcomes over 10 years of follow-up. Study limitations include a small cohort size, retrospective data, unknown infertility rates and attrition. While our study offers a hopeful longer-term message for patients with SSc who are planning a pregnancy, physicians and patients should remain vigilant for potential post-partum complications.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/systemic-sclerosis-progression-and-pregnancy-a-hopeful-message-from-the-canadian-scleroderma-registry-database/