Systemic Sclerosis in Pregnancy Linked to Fourfold Higher Risk of Pre-eclampsia and Low Birth Weight: Study
France: A new prospective study from France, published in The Lancet Rheumatology, has shed light on the heightened pregnancy risks faced by women with systemic sclerosis (SSc) and very early diagnosis of systemic sclerosis (VEDOSS). The research highlights the need for specialized maternal care and close monitoring during and after pregnancy for this high-risk population.
Anne Murarasu from Université Paris Cité and Hôpital Cochin, and colleagues examined data from 58 pregnancies in 52 women with systemic sclerosis enrolled in the GR2 French prospective study between 2014 and 2020. Despite a high live birth rate (91.4%), the findings revealed a significantly greater frequency of complications compared with the general French population.
The study led to the following notable findings:
- Women with systemic sclerosis had a fourfold higher risk of pre-eclampsia (13.2% vs 3%).
- The likelihood of preterm delivery was greater in women with systemic sclerosis (13.2% vs 5.8%).
- The incidence of low birth weight infants was markedly higher in this group (21.1% vs 4.3%).
- Severe postpartum hemorrhage occurred in 11.3% of cases, compared with 1.4% in the control population.
- Nearly 40% of pregnancies showed worsening of systemic sclerosis or VEDOSS, most frequently during the postpartum period.
- Diffuse cutaneous systemic sclerosis (OR 3.7) and previous cutaneous vascular involvement (OR 3.7) were significant predictors of disease progression.
- The presence of anticentromere antibodies was associated with a protective effect against disease worsening (OR 0.2).
- No single factor was significantly linked to adverse pregnancy outcomes.
- Women with systemic sclerosis remained highly susceptible to maternal and fetal complications.
- Placental insufficiency-related complications, such as pre-eclampsia and fetal growth restriction, were observed in about 22.6% of pregnancies.
The authors stressed the importance of multidisciplinary management, involving both rheumatologists and obstetric specialists, to minimize risks and ensure timely detection of complications. They also noted that careful monitoring during the postpartum phase is crucial, as this is when disease flare-ups are most frequent.
Despite the challenges, the overall pregnancy success rate was encouraging, with more than nine in ten pregnancies resulting in live births. However, the elevated rates of preterm birth, low birth weight, and postpartum hemorrhage underscore the need for vigilance.
"The study provides valuable prospective evidence that pregnancies in women with systemic sclerosis, while increasingly possible, are still accompanied by notable maternal and fetal risks. Optimized pre-pregnancy counseling, close follow-up, and individualized treatment approaches are vital to improve outcomes and safeguard both maternal and infant health," the authors concluded.
Reference:
Murarasu, A., Beaudeau, L., Le Guern, V., Guettrot-Imbert, G., Cazalets, C., Durant, C., Yelnik, C., Lartigau Roussin, C., Besse, M., Berthoux, E., Chatelus, E., Hachulla, E., Lazaro, E., Maurier, F., Leroux, G., Pugnet, G., Durieu, I., Raffray, L., Le Besnerais, M., . . . YELNIK, C. (2025). Fetal and maternal outcome in the pregnancies of patients with systemic sclerosis and very early diagnosis of systemic sclerosis in France: A prospective study. The Lancet Rheumatology. https://doi.org/10.1016/S2665-9913(25)00185-7
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