Pregnancy is a time of joy and anticipation, but for women with systemic sclerosis (SSc), it can also be a period of heightened risk and uncertainty. A groundbreaking French study has unveiled alarming disparities in pregnancy outcomes for these women, sparking crucial conversations about specialized care and monitoring. But here's where it gets even more critical: the research reveals not only elevated risks during pregnancy but also significant postpartum challenges that demand our attention.
This eye-opening study, part of the GR2 French prospective registry, tracked 58 pregnancies in 52 women diagnosed with systemic sclerosis or Very Early Diagnosis of Systemic Sclerosis (VEDOSS) between 2014 and 2020. Its goal? To uncover the frequency of adverse pregnancy outcomes and pinpoint factors predicting disease progression in mothers. The results are both illuminating and concerning.
While a promising 91.4% of pregnancies resulted in live births, a staggering 26.4% faced composite adverse outcomes. These included preterm births before 34 weeks, placental insufficiency, small-for-gestational-age infants, and even fetal or neonatal death. And this is the part most people miss: placental complications like preeclampsia and fetal growth restriction occurred in 22.6% of cases, while severe postpartum hemorrhage affected 11.3% of women—far surpassing the 1.4% rate in the general French population.
When compared to over 500 age-matched controls from France’s 2016 national perinatal survey, the disparities were stark. Women with SSc experienced higher rates of preeclampsia (13.2% vs. 3.0%), preterm birth before 37 weeks (13.2% vs. 5.8%), low birthweight under 2,500 g (21.1% vs. 4.3%), and severe postpartum hemorrhage (11.3% vs. 1.4%). These findings underscore the urgent need for specialized obstetric and rheumatology care tailored to this high-risk group.
But here’s the controversial part: while most women with SSc can have successful pregnancies, the study found that the disease worsened in nearly 40% of cases, primarily after delivery. Women with diffuse cutaneous SSc or a history of cutaneous vascular involvement were particularly vulnerable to postpartum flare-ups. Conversely, those with anticentromere antibodies tended to remain stable. This raises a thought-provoking question: Are we doing enough to identify and manage these high-risk features early on?
Lead author Anne Murarasu of Paris Descartes University emphasizes, “Our results highlight the need for close, multidisciplinary follow-up, especially in the postpartum period. While successful pregnancies are possible, the risk of maternal and fetal complications remains significantly elevated.”
This study isn’t just about numbers—it’s a call to action. It stresses the importance of individualized preconception counseling and tailored pregnancy monitoring for women with SSc. Early identification of high-risk factors, such as diffuse cutaneous involvement, could pave the way for closer surveillance and proactive management, optimizing outcomes for both mother and child.
So, here’s the question for you: With such clear evidence of elevated risks, should specialized care for pregnant women with SSc become the standard, or is more research needed? Share your thoughts in the comments—let’s keep this vital conversation going.
Reference:
Murarasu AAV et al. Fetal and maternal outcome in the pregnancies of patients with systemic sclerosis and very early diagnosis of systemic sclerosis in France: a prospective study. Lancet Rheumatol. 2025;DOI: 10.1016/S2665-9913(25)00185-7.
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