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Delay pregnancy until scleroderma stabilizes. (Diffuse Disease).
NEW ORLEANS -- Women with diffuse scleroderma, including those with a previous renal crisis, should delay pregnancy until their disease has stabilized, Dr. Virginia Steen said at the Third International Conference on Sex Hormones, Pregnancy, and the Rheumatic Diseases.
Before 1985, doctors told most women with scleroderma not to get pregnant, because pregnancy outcomes were poor for both them and their babies. Now women with milder or stable disease can have good pregnancy outcomes without high rates of miscarriages and preterm births, said Dr. Steen, professor of medicine at Georgetown University, Washington, D.C.
Dr. Steen noted a prospective trial at the University of Pittsburgh in which 26 women had limited scleroderma and 41 pregnancies and 33 women with diffuse scleroderma had 50 pregnancies from 1987 to 1996. Only women with late diffuse disease had a significant increase in the frequency of miscarriage, compared with the other women,
Prematurity occurred in 29% of the pregnancies as a whole. However, 60% of the pregnancies in women with early diffuse disease were marked by premature delivery a significantly greater percentage than that seen in women with other manifestations of the disease. Only one of the premature infants died (Obstet. Gynecol. 94[1]:15-20, 1999).
The severity of scleroderma symptoms during pregnancy did not change significantly afterward, and "some patients actually felt they improved," she said at the conference, sponsored by the University of Connecticut and the University of Utah.
Some women with Raynaud's phenomenon reported feeling better during--but worse after--pregnancy A small number of patients with diffuse disease had worse skin disease symptoms when they stopped medication such as methotrexate during pregnancy.
Two women with early diffuse disease had a renal crisis during pregnancy; early diffuse disease is a major risk factor for renal crisis, Dr. Steen said. One woman elected to have an abortion; the other had a preterm infant who eventually did well.
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Source: HighBeam Research, Delay pregnancy until scleroderma stabilizes. (Diffuse Disease).