Systemic sclerosis & Raynaud's
Fetal and maternal outcome in the pregnancies of patients with systemic sclerosis and very early diagnosis of systemic sclerosis in France: a prospective study
Authors' conclusion
Despite 53 (91.4%) of 58 livebirths, systemic sclerosis pregnancies were associated with higher rates of adverse pregnancy outcomes and severe postpartum haemorrhage.
Study context
- Population
- Pregnant women with SSc or VEDOSS in the GR2 French prospective study, 2014–202058 pregnancies in 52 women
- Participants
- 58 vs 530
- Exposure
- SSc or VEDOSS pregnancies vs age-matched controls from the French perinatal survey (ENP) 2016
- SSc/VEDOSSn = 58
- ENP 2016n = 530reference
- Outcome
- Frequency of composite adverse pregnancy outcomes (preterm birth ≤34 weeks, placental insufficiency complications, small for gestational age, or fetal or neonatal death) and maternal disease course
Methodological detailsmulticentre, comparison with age-matched controls from ENP 2016
- Multicentre
- Comparison with age-matched controls from ENP 2016
Main finding
As reported in the abstract
Composite adverse pregnancy outcome: 14 of 53 ongoing pregnancies beyond 22 weeks
26.4%
SSc or VEDOSS worsened, mainly postpartum: 23 of 58 pregnancies
39.7%
Observational data: associations, not effects.
Secondary outcomes
Livebirths: 53 of 58 pregnancies
- Livebirths: 53 of 58 pregnancies
- 91.4%
Components of composite adverse pregnancy outcome (of 53 ongoing pregnancies)
- Preterm deliveries at ≤34 weeks: 2 of 53
- 3.8%
- Placental insufficiency complications (pre-eclampsia or fetal growth restriction): 12 of 53
- 22.6%
- Small for gestational age: 6 of 53
- 11.3%
Severe postpartum haemorrhage: 6 of 53 pregnancies
- Severe postpartum haemorrhage: 6 of 53 pregnancies
- 11.3%
Outcomes vs age-matched controls from the 2016 ENP survey (general population)
- Pre-eclampsia: 7 [13.2%] of 53 vs 16 [3.0%] of 530
- P = 0.0010
- Preterm birth before 37 weeks: 7 [13.2%] of 53 vs 31 [5.8%] of 530
- P = 0.047
- Birthweight <2500 g: 11 [21.1%] of 52 vs 23 [4.3%] of 530
- P < 0.0001
- Severe postpartum haemorrhage: 6 [11.3%] of 53 vs 7 [1.4%] of 516
- P = 0.0001
- More frequent than in the general population
Predictors of composite adverse pregnancy outcome (univariate)
- No factors significantly associated with the composite adverse pregnancy outcome
Predictors of maternal disease progression (univariate)
- dcSSc, OR
- 3.7 (95% CI 1.1-12.4)
- Previous cutaneous vascular involvement, OR
- 3.7 (95% CI 1.2-11.5)
- Anticentromere antibodies, inversely associated with stable disease, OR
- 0.2 (95% CI 0.1-0.8)
Safety
Severe postpartum haemorrhage vs general population
P = 0.0001
- Severe postpartum haemorrhage vs general population: ENP denominator 516
Original publication
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