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Outcome of pregnancies complicated by systemic sclerosis and mixed connective tissue disease

Division of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA

R LR Flyckt

Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, USA

I Colón

Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, USA

A A Shah

Division of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA

M Druzin

Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, USA

E F Chakravarty

Division of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA, echakravarty{at}stanford.edu

Systemic sclerosis (SSc) and mixed connective tissue disease (MCTD) are rare autoimmune diseases which share the common feature of non-inflammatory vasculopathy. Studies evaluating pregnancy outcomes in these patients have yielded conflicting results. We sought to describe the outcomes of pregnancies associated with SSc and MCTD followed at our center utilizing a retrospective review of all pregnant women with SSc and MCTD followed at Stanford University from 1993 to 2003.

We identified 20 pregnancies occurring in 13 women with SSc or MCTD. Twelve pregnancies occurred in seven women with SSc and eight pregnancies occurred in six women with MCTD. The overall preterm delivery rate was 39% and small for gestational age infants occurred in 50% and 63% of pregnancies associated with SSc and MCTD, respectively. Fetal loss complicated two pregnancies in women with severe diffuse SSc and the antiphospholipid antibody syndrome. There were no cases of congenital heartblock among infants, and only one case of pre-eclampsia was observed. Maternal flares of disease during pregnancy were generally mild.

Most pregnancies in women with SSc and MCTD in this cohort were uncomplicated. The high rates of prematurity and small for gestational age infants underscore the risk for growth restriction consistent with the vasculopathy associated with these diseases.

Key Words: mixed connective tissue disease • outcomes • pregnancy • systemic sclerosis

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