A history of adverse pregnancy events, including hypertensive disorders of pregnancy, premature rupture of membranes, intrauterine growth restriction (IUGR), maternal infections, and neonatal intensive care unit (NICU) admissions, may be more common among women who subsequently develop systemic sclerosis (SSc) compared with the general obstetric population, according to study results published in Arthritis Care and Research.
Limited data exist on adverse pregnancy events prior to a diagnosis of SSc. The objective of the current study was to determine the risk for obstetric complications preceding a diagnosis of SSc compared with the general obstetric population.
In the current retrospective case-control study, the researchers used data from Kaiser Permanente Northern California that included adult women with prior obstetric complications who later developed SSc and women who did not develop SSc (control participants matched 10:1 by age and year of delivery).
The primary exposure of interest was hypertensive disorders of pregnancy, including preeclampsia, eclampsia, and gestational hypertension. Secondary exposures included premature rupture of membranes, intrauterine growth restriction, maternal infections, neonatal intensive care unit admissions, preterm delivery, mode of delivery, and stillbirths. The primary outcome was subsequent diagnosis of SSc.
The study sample included 17 patients who developed SSc and 170 control participants with singleton pregnancies (median maternal age at delivery, 34 years). Median gestational age was 39 weeks for both groups. Limited cutaneous disease was documented in 13 of the 17 women who subsequently developed SSc, with a median time from delivery to SSc diagnosis of 2 years (range, 0.2-7.3 years).
Overall, obstetric complications were higher in the SSc group compared with the control group (70.6% vs 50%; P =.13). Compared with the control group, the SSc group had higher frequencies of individual obstetric complications, including hypertensive disorders (9.4% vs 17.7%), premature rupture of membranes (4.1% vs 11.8%), IUGR (1.8% vs 5.9%), maternal infection (14.1% vs 29.4%), NICU admissions (7.7% vs 23.5%), and preterm delivery (21.8% vs 29.4%).
Researchers also noted that women who developed SSc vs control participants were more likely to be Hispanic and Black (41.2% vs 18.8% and 11.8% vs 2.4%, respectively) than White.
In conditional logistic regression analyses, women who subsequently developed vs did not develop SSc had a higher but nonstatistically significant risk for any obstetric complication during pregnancy (odds ratio [OR], 2.6; 95% CI 0.8-7.9). Women who eventually developed SSc had a significantly increased risk of delivering infants requiring NICU admissions (OR, 4.7; 95% CI, 1.2-18.8), after adjusting for race/ethnicity.
The study had several limitations, including the relatively small sample size, inclusion limited to community-based health care organization with medical insurance, and no available data on the number of women with infertility or miscarriages prior to 20 weeks.
“Assessing adverse reproductive outcomes in patients newly diagnosed with SSc may be helpful as part of the initial evaluation and may provide insight into mechanisms and etiology of adverse pregnancy outcomes,” the researchers concluded.
Chung MP, Kolstad KD, Dontsi M, et al. Increased rates of obstetric complications prior to systemic sclerosis diagnosis. Arthritis Care Res (Hoboken). Published online December 8, 2020. doi:10.1002/acr.24533