Scleroderma is a chronic autoimmune disease causing the buildup of excess collagen in the connective tissue. The most common symptom of scleroderma is patches of scar-like thick skin, but the condition may also affect other organs including the heart, blood vessels, lungs, and kidneys, potentially causing complications during pregnancy.
Scleroderma and fertility
Fertility is usually not affected by scleroderma. However, some medications women with the condition may be using, such as cyclophosphamide and methotrexate, can cause infertility or miscarriage. Therefore, it is important that women with scleroderma consult with healthcare providers before trying to get pregnant.
Risks associated with scleroderma during pregnancy
Women with scleroderma who are expecting children are considered to have high-risk pregnancies. They are therefore closely monitored by an obstetrician and may be treated by a multidisciplinary team of joint, heart, kidney, skin, and lung specialists.
The first three years after scleroderma symptoms appear are known as the critical years, because symptoms may spontaneously worsen and patients may experience flares. For this reason, women are discouraged to get pregnant during this period.
After the first three years of disease onset, scleroderma-associated risks during pregnancy mostly depend on the type of scleroderma the patient has. For instance, women with localized scleroderma, in which symptoms are usually limited to the skin and muscles, might not encounter any major problems caused by the condition during their pregnancy. On the other hand, systemic scleroderma patients may experience serious issues such as kidney failure and high blood pressure (preeclampsia) when they get pregnant.
In the event of a persisting complication, the doctor may decide to deliver the baby prematurely by Cesarean section as long as the woman is at least 25 weeks along in her pregnancy. However, with the help of specialist care, most women with scleroderma are able to manage their symptoms and deliver healthy babies.
How scleroderma affects the baby
Pregnant women with scleroderma may develop a condition called placental insufficiency, which causes inadequate blood supply to the placenta, resulting in fewer nutrients being delivered to the baby. For this reason, some babies are born smaller than average to mothers with scleroderma.
More than 95 percent of scleroderma patients have autoantibodies in their blood. Anti-Ro (SSA) and anti-LA (SSB) are two autoantibodies seldom found in people with scleroderma. The presence of these may cause heart problems in the baby until the 25th week of pregnancy. Therefore, the fetus of women with these two antibodies in their blood should regularly be monitored by an echocardiogram. Corticosteroid treatment may be necessary if any inflammation is observed.
How pregnancy affects scleroderma symptoms
Some patients’ scleroderma symptoms may worsen with pregnancy, but usually only if they became pregnant within the critical first three years of scleroderma onset.
One study found that pregnant women with scleroderma had less numbness in the fingers and toes, a common scleroderma symptom knows as Raynaud’s phenomenon. However, they experienced an increase in other scleroderma symptoms such as esophageal dysfunction causing heartburn. But this may not be due to scleroderma since heartburn is a common complaint during pregnancy.
Skin problems do not typically worsen as a result of stretching due to the growing baby.
Scleroderma treatment during pregnancy
It may not be safe to use some scleroderma medications during pregnancy. Patients should inform their physicians about their intentions to get pregnant, as well as which scleroderma medications they have been using, so their disease management can be better planned.
Some treatments, such as immune system-suppressing medications, angiotensin-converting enzyme (ACE) inhibitors, and blood pressure medications are not safe and should be stopped during pregnancy.
Other therapies can be given at lower doses or switched to a safer alternative based on the phase of the pregnancy. For instance, when used in the early phases of pregnancy, corticosteroids can cause birth defects. On the other hand, nonsteroidal anti-inflammatory medications, such as ibuprofen, can be unsafe in the later phases of a pregnancy as they may interfere with labor.
Scleroderma News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.