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Pregnancy and Systemic Scleroderma

Author: Shelley Ensz. Scleroderma is highly variable. See Types of Scleroderma. Read Disclaimer
Autoimmunity and Pregnancy
Autoimmunity and Menopause
Antidepressants/Fetal P.H.
PostPartum Psychosis
Preeclampsia
Infertility
Medications and Pregnancy
Scleroderma and Pregnancy
Slide Show
Smoking and Pregnancy
Personal Stories
Related Information

Pregnancy and Scleroderma

This information on pregnancy applies only to systemic sclerosis (scleroderma) —such as diffuse, limited, CREST, and overlap —and not to localized forms, such as linear or morphea. (Also see: What is Scleroderma?, Types of Scleroderma, and Systemic Sclerosis
It is very important to consult your medical team if you are contemplating a scleroderma pregnancy, since medications may need to be adjusted beforehand, and specific risk issues can be addressed.
Many systemic scleroderma patients are able to successfully bear children, however it is always considered a "high risk" pregnancy and extra monitoring and precautions are necessary, both before and during pregnancy.
Common sense must prevail, of course. Patients with rapid onset or severe internal organ involvement may need to postpone pregnancy until the symptoms abate or toxic treatments are completed. Depending on the situation, a few people may still be advised to forego pregnancy plans altogether, or to select another route to parenthood (such as adoption or surrogate parenthood).
Increased incidence of pregnancy complications in women who later develop scleroderma: a case control study. This is the first study to show an association between hypertensive complications during pregnancy or IUGR and the development of systemic sclerosis (SSc) at a later age. We speculate that the pregnancy abnormalities may have resulted in increased fetomaternal trafficking, which may have played a role in the increased incidence of SSc. Arthritis Research & Therapy 2011, 13:R183. (Also see: Causes of Scleroderma: Fetal Cells)
Pregnancy issues in scleroderma. This review focuses on the effects of scleroderma on fertility and pregnancy as well as on the management of pregnancy and delivery in the scleroderma patient. Autoimmun Review, 2011 Dec 3.
Increased incidence of pregnancy complications in women who later develop scleroderma: a case control study. This is the first study to show an association between hypertensive complications during pregnancy or IUGR and the development of SSc at a later age. Arthritis Res Ther. 2011 Nov 4;13(6):R183.
Systemic sclerosis and pregnancy. Pregnancy in women diagnosed with systemic sclerosis is an infrequent situation with a generally favourable outcome according to the most recent studies. L Josselin-Mahr. (PubMed) Rev Med Interne. 2010 Jul 13.
The management of rheumatic diseases in pregnancy. In general, active inflammation from rheumatic diseases poses a stronger threat to the well-being of both mother and foetus than many immunosuppressant medications. Therefore, continued immunosuppression with the least risky medications will allow for the most optimal pregnancy outcomes. K. Mitchell. (PubMed) Scand J Rheumatol. 2010 Mar;39(2):99-108.
L-Arginine in pregnant scleroderma patients. Systemic sclerosis (SSc) pregnant women show a high frequency of premature births and occurrence of renal crisis. Some evidences showed the role of L-arginine in the prevention and treatment of preeclampsia. Dilia Giuggioli. (SpringerLink) Clinical Rheumatology. March 10, 2010.

Slide Show: Pregnancy and Scleroderma

Scleroderma and Pregnancy an online slide show by Asim Iqbal, MD, Department of Obstetrics and Gynecology, Nishtar Hospital, Multan, Pakistan. (Also see: ISN: Dr. Iqbal and "Case of the Unfortunate Fetus" in Voices of Scleroderma Volume 1 book.)

Antidepressants and Fetal Pulmonary Hypertension

Antidepressants: Safe during pregnancy? Taking antidepressants during pregnancy may pose health risks for your baby — but stopping may pose risks for you. Get the facts about antidepressants and pregnancy. MayoClinic. Dec. 2009.
Antidepressant medication use and risk of persistent pulmonary hypertension of the newborn. We did not find an association between SSRI use in late pregnancy and PPHN. Limitations of the present study, including the small number of confirmed cases, suggest further research in this area may be warranted. Andrade SE, (PubMed) Pharmacoepidemiol Drug Saf. 2009 Mar;18(3):246-52.

Preeclampsia

Genetic errors linked to life-threatening pregnancy disorder. Scientists have identified genetic errors in women with autoimmune diseases that increase the risk of preeclampsia, a potentially life-threatening condition that occurs in 10 percent of all pregnancies. Media-Newswire.com. 03/29/2011.
Gene That Helps Regulate Immune System is Linked to Preeclampsia, Researchers Find. Researchers at North Carolina State University have discovered that the placentas of women who suffer preeclampsia during pregnancy have an overabundance of a gene associated with the regulation of the body's immune system. Their discovery may lead to improved screening and prenatal care for these patients and their babies. HealthCanal. 02/11/2011.

Medications and Pregnancy

Paternal Exposure to Methotrexate and Pregnancy Outcomes. Based on our results and case reports in literature, paternal MTX exposure at the time of conception does not seem to raise any major concern for offspring. Delphine Beghin. The Journal of Rheumatology vol. 38 no. 4 628-632. (Also see: Medications)
The use of anti-TNFα medications for rheumatologic disease in pregnancy. Anti-TNFα medications have led to vast improvements in the treatment of inflammatory conditions, however after an analysis of the FDA-reported anomalies it appears that significant levels of these drugs cross the placenta as the pregnancy nears term, but little is passed through breast milk. Megan EB. (DovePress) Clowse International Journal of Women's Health June 2010 , Volume 2010:2 Pages 199 - 209.

Smoking and Pregnancy

Smoking poses increased dangers for systemic scleroderma patients, since they are also prone to many types of lung involvement. Smoking also worsens Raynaud's, often leading to digital ulcers, gangrene, and amputation.

Personal Stories: Pregnancy and Scleroderma

Personal Stories about Pregnancy and Scleroderma. These are our personal patient and caregiver stories about pregnancy and systemic sclerosis (scleroderma). ISN.

Related Information

Causes of Scleroderma: Genetics ISN.
Voices of Scleroderma Volume 1 book features an article, "The Case of the Misfortunate Fetus" by Asim Iqbal, MD, Department of Obstetrics and Gynecology, Nishtar Hospital, Multan, Pakistan.
 
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