A NEW French study has shed light on the complex challenges faced by pregnant women with systemic sclerosis (SSc), revealing higher risks of pregnancy complications and postpartum disease progression compared to the general population. The findings provide crucial evidence for improving care and monitoring in this high-risk group.
Prospective Data From a National Cohort
The study, part of the GR2 French prospective registry, followed 58 pregnancies in 52 women diagnosed with systemic sclerosis or with Very Early Diagnosis of Systemic Sclerosis (VEDOSS) between 2014 and 2020. Researchers aimed to quantify the frequency of adverse pregnancy outcomes and identify predictors of maternal disease progression.
Overall, 91.4% of pregnancies resulted in livebirths, but 26.4% experienced composite adverse outcomes, including preterm birth at 34 weeks or earlier, placental insufficiency, small-for-gestational-age infants, or fetal and neonatal death.
The rate of placental complications such as preeclampsia and fetal growth restriction reached 22.6%, and severe postpartum hemorrhage occurred in 11.3% of cases, significantly higher than the 1.4% seen in the general French perinatal survey.
Increased Risk Compared With General Population
When compared with more than 500 age-matched controls from France’s 2016 national perinatal survey, systemic sclerosis pregnancies showed higher rates of preeclampsia (13.2% versus 3.0%), preterm birth before 37 weeks (13.2% versus 5.8%), low birthweight under 2,500 g (21.1% versus 4.3%), and severe postpartum hemorrhage (11.3% versus 1.4%).
These findings emphasize the importance of specialized obstetric and rheumatology care for women with SSc or VEDOSS before, during, and after pregnancy.
Disease Progression Postpartum
Beyond obstetric complications, the study found that systemic sclerosis worsened in nearly 40% of pregnancies, mainly after delivery. Women with diffuse cutaneous SSc or a history of cutaneous vascular involvement were at particularly high risk of postpartum disease flare-ups. Conversely, those with anticentromere antibodies were more likely to remain stable.
“Our results highlight the need for close, multidisciplinary follow-up, especially in the postpartum period,” said lead author Anne Murarasu of Paris Descartes University. “While most women with systemic sclerosis can have successful pregnancies, the risk of maternal and fetal complications remains significantly elevated.”
Toward Better Risk Prediction and Counseling
The findings underscore the need for individualized preconception counseling and tailored pregnancy monitoring in systemic sclerosis. Researchers stress that early identification of high-risk features such as diffuse cutaneous involvement could guide closer surveillance and proactive management to optimize outcomes for both mother and child.
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.
