Pregnancy in Systemic Sclerosis 4.5/5 (4)

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General

The possibility of a successful pregnancy depends on whether the disease has attacked internal organs and the extent of the disease. The disease course by Systemic sclerosis (systemic scleroderma) is usually not affected much by pregnancy, and pregnancy is often feasible, but with some important exceptions:

  • Pulmonary hypertension is definitely contraindication (prohibition) against getting pregnant
  • Do not get pregnant if severe renal impairment is present
  • Seriously reduced pulmonary or cardiac function is contraindication
  • The drugs that contain methotrexate or mycophenolate (MMF) / CellCept must not be used during pregnancy

At systemic sclerosis, the average 25% of children are born prematurely (compared to 12% in the general population)

The disease activity and the course of systemic sclerosis are approximately unchanged throughout pregnancy, comparable to those who are not pregnant. However, complications are more difficult to treat

  • Most often complications of the diffuse cutaneous type (skin changes on more than arms, legs and face)
  • Heart, lung and kidney complications can occur especially among those with the antibodies Scl-70 or RNA polymerase III
  • Kidney/renal crisis (must be treated with ACE inhibitors despite risk to the fetus, see below)
  • Pulmonary hypertension (serious for the pregnant and the fetus)
  • Abnormal heart rhythms (serious for the pregnant and the fetus)
  • Some increased joint pain is common
  • Skin symptoms are as expected

Renal crisis during pregnancy

Life-threatening complication

  • Daily increasing kidney failure (increasing blood creatinine) and blood pressure increase
    • Pre-eklapsi as differential diagnosis (increasing serum uric acid, proteinuria and liver enzymes increase in some)
  • Please read more about the renal crisis here
  • Treatment
    • Trandate and / or Adalat / Adalat Oros
    • If the treatment does not have sufficient effect, must ACE inhibitor be considered to save the patient's life even if the risk of fetal injury occurs

Checklist when pregnancy in systemic sclerosis is planned

  • Prohibited drugs, Please read more here
  • Signs of organ damage must be considered before pregnancy
  • Check Vitamin D and iron status (25-OH white D, transferrin receptor). Possible reduced opptake from the intestine by systemic sclerosis can lead to low vitamin D in the bloodstream
  • Antibodies against ScL-70 and RNA polymerase III increases the risk of complication during pregnancy
  • Antiphospholipid antibody should be checked even if increased incidence is not expected in systemic sclerosis
  • Gynecological assessment is considered
  • General information about the disease and about pregnancy

Checklist for pregnancy in systemic sclerosis

Followed up as a "risk pregnancy"

  • Drugs allowed (if necessary)
  • Prednisone or other corticosteroids are avoided or used in the lowest possible dose
  • Follow up also at the maternity ward / birth clinic
    • Fetal growth
    • Blood Circulation
  • Check signs of premature birth

Checklist at birth in systemic sclerosis

  • Inform the delivery room if the skin is affected by the disease
    • May cause problems for anesthesia and to find venous access
  • Regional anesthesia (spinal / epidural) is preferred over narcosis (intubation)
  • Episotomi or wounds by cesarean usually grows uncomplicated
  • After birth
    • Follow blood pressure

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