TOPLINE:

Pregnancies in women with systemic sclerosis (SSc) showed a 91.4% live birth rate, but women with SSc had higher rates of adverse pregnancy outcomes, such as preeclampsia, preterm birth, and severe postpartum hemorrhage, than those in the general population. Nearly 40% of pregnancies had worsening of disease during pregnancies or within 12 months postpartum.

METHODOLOGY:

• Researchers prospectively analyzed data from an observational study on pregnancy in women with rare autoimmune diseases, conducted at 76 hospitals in France; they included pregnant women with SSc or very early diagnosis of SSc, with data collected up to 1 year postpartum using electronic case reports.
• A total of 58 pregnancies in 52 women (median age at pregnancy, 34 years; median disease duration, 3 years) enrolled between May 2014 and December 2020 were included, comprising those with diffuse cutaneous SSc (n = 16), limited cutaneous SSc (including those with SSc sine scleroderma; n = 30), or a very early diagnosis of SSc (n = 6).
• The primary objectives included assessing the proportion of pregnancies with composite adverse pregnancy outcomes, which included the occurrence of any complication related to placental insufficiency, preterm birth at or before 34 weeks, small-for-gestational-age infants, or fetal death after 22 weeks of gestation, with or without neonatal death within a month. They also assessed any worsening of maternal disease.
• Single pregnancies were matched for maternal age and gestational status with pregnancies in the French general population using data from the 2016 French perinatal survey (n = 530) to assess differences in outcomes.
• The study also assessed other pregnancy-related complications, such as delivery outcomes and postpartum complications, along with predictive factors for adverse pregnancy outcomes and disease worsening.

TAKEAWAY:

• Overall, 91.4% of pregnancies resulted in live births, of which 26.4% had composite adverse pregnancy outcomes, with placental insufficiency in 22.6% (including preeclampsia in 13.2% and fetal growth restriction in 9.4%), preterm birth at or before 34 weeks in 3.8%, and small-for-gestational-age infants in 11.3%.
• Of the eight pregnancies in women with very early diagnosis of SSc, fetal losses occurred in two before 22 weeks of gestation, and 33.3% of the remaining had a composite adverse pregnancy outcome. Worsening gastroesophageal reflux disease occurred in 34.5% of all pregnancies, and disease worsening during pregnancies or within 12 months postpartum occurred in 39.7% of pregnancies.
• Women with SSc vs general population had higher rates of preeclampsia (13.2% vs 3.0%), preterm birth before 37 weeks (13.2% vs 5.8%), and severe postpartum hemorrhage (11.3% vs 1.3%; P < .05 for all).
• Diffuse cutaneous SSc (odds ratio [OR], 3.7; 95% CI, 1.1-12.4) and prior cutaneous vascular involvement (OR, 3.7; 95% CI, 1.2-11.5) were linked to disease worsening, whereas the presence of anticentromere antibodies showed an inverse association with disease worsening (OR, 0.2; 95% CI, 0.1-0.8).

IN PRACTICE:

“These findings underscore the importance of obstetric-specific monitoring for pregnant women with systemic sclerosis or VEDOSS [very early diagnosis of SSc], particularly for early detection and management of preeclampsia,” the authors wrote.

“Multidisciplinary care, including phenotype-based risk assessment, antenatal monitoring, and postpartum rheumatology review, especially for those with diffuse cutaneous systemic sclerosis or vascular involvement, needs to be standard practice,” experts wrote in a related comment.

SOURCE:

The study was led by Anne Murarasu, MD, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France. It was published online on October 28, 2025, in The Lancet Rheumatology.

LIMITATIONS:

The study’s focus on live births after 22 weeks limited conclusions about complications in the first trimester. Women with severe organ damage or conditions such as pulmonary arterial hypertension were not included. The modest sample size may have affected the statistical power for some analyses.

DISCLOSURES:

The study was supported by Lupus France, Association des Sclérodermiques de France, Association Gougerot Sjögren, and other sources. Some authors reported receiving support for attending meetings; grants; consulting fees; or honoraria for presentations, speaker bureaus, or advisory roles from various pharmaceutical companies, including GSK, Bristol Myers Squibb, and Novartis.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.