PT - JOURNAL ARTICLE AU - Jelena Blagojevic AU - Khitam Abdullah AlOdhaibi AU - Aly M. Aly AU - Silvia Bellando-Randone AU - Gemma Lepri AU - Cosimo Bruni AU - Alberto Moggi-Pignone AU - Serena Guiducci AU - Federico Mecacci AU - Marco Matucci-Cerinic AU - Daniel E. Furst TI - Pregnancy in Systemic Sclerosis: Results of a Systematic Review and Metaanalysis AID - 10.3899/jrheum.181460 DP - 2019 Sep 01 TA - The Journal of Rheumatology PG - jrheum.181460 4099 - http://www.jrheum.org/content/early/2020/02/10/jrheum.181460.short 4100 - http://www.jrheum.org/content/early/2020/02/10/jrheum.181460.full AB - Objective Through a systematic literature search (SLR) and metaanalysis, to determine maternal and fetal outcomes in pregnancies involving systemic sclerosis (SSc), to analyze the effect of pregnancy on disease activity, and to examine predictors of fetal and maternal outcomes. Methods An SLR was performed for articles on SSc and pregnancy published between 1950 and February 1, 2018. Reviewers double-extracted articles to obtain agreement on > 95% of predefined critical outcomes. Results Out of 461 publications identified, 16 were included in the metaanalysis. The metaanalysis showed that pregnancies involving SSc were at higher risk of miscarriage (OR 1.6, 95% CI 1.22–2.22), fetuses with intrauterine growth retardation (IUGR; OR 3.2, 95% CI 2.21–4.53), preterm births (OR 2.4, 95% CI 1.14–4.86), and newborns with low birth weight (OR 3.8, 95% CI 2.16–6.56). Patients with SSc had a 2.8 times higher chance of developing gestational hypertension (HTN; OR 2.8, 95% CI 2.28–3.39) and a 2.3 times higher chance of cesarean delivery compared to controls (OR 2.3, 95% CI 1.37–3.8). The definitions of disease worsening/new visceral organ involvement were too inexact to have any confidence in the results, although worsening or new disease manifestations during pregnancy in 44/307 cases (14.3%) and 6 months postpartum in 32/306 cases (10.5%) were reported. The data did not permit definition of predictors of disease progression and of maternal and fetal outcomes. Conclusion Pregnancies involving SSc have increased frequency of miscarriages, IUGR, preterm deliveries, and newborns with low birth weight compared to healthy controls. Women with SSc were more prone to develop gestational HTN and to undergo cesarean delivery. Disease manifestations seem to remain stable or improve in most patients.