Impact of Systemic Sclerosis on Pregnancy Outcomes: A Swedish Study

Systemic sclerosis, a chronic autoimmune disease, poses significant risks for women during pregnancy, according to a recent study published in the journal *Arthritis & Rheumatology* on July 8, 2025. This research, conducted by Dr. Weng Lan Che and colleagues at the Karolinska Institutet in Stockholm, utilized data from Swedish national health registers spanning from 1987 to 2021 to evaluate pregnancy outcomes in women diagnosed with systemic sclerosis (SSc) compared to a matched cohort of women without the disease.

The study encompassed a total of 972 pregnancies in women with systemic sclerosis, which were divided into those occurring before (878 pregnancies) and after (94 pregnancies) the diagnosis of the condition. The researchers aimed to elucidate the adverse pregnancy outcomes associated with systemic sclerosis, including preeclampsia, gestational hypertension, preterm birth, and cesarean delivery.

### Context and Significance The findings from this cohort study are particularly alarming, highlighting that women with systemic sclerosis face markedly higher risks for several adverse pregnancy outcomes. Specifically, postdiagnosis pregnancies were associated with an adjusted relative risk (aRR) of 3.8 for preeclampsia (95% confidence interval [CI], 1.8-7.8) and 3.3 for preterm birth (95% CI, 1.8-6.1). Furthermore, the risk for cesarean delivery was found to be 2.5 times greater (95% CI, 1.8-3.5).

Particularly noteworthy is the data indicating that primiparous women—those who are pregnant for the first time—exhibit a staggering 7.5-fold increased risk for preeclampsia and a 5.1-fold increased risk for preterm birth. This emphasizes the necessity for targeted care and counseling for women with systemic sclerosis contemplating pregnancy.

### Methodology The study methodology involved a comprehensive analysis of national health register data, which allowed the researchers to categorize pregnancies according to their timing in relation to the diagnosis of systemic sclerosis. Pregnancies were classified as occurring either within 0-3 years before diagnosis or more than 3 years prior. This stratification revealed that pregnancies occurring within 0-3 years of a diagnosis had an adjusted odds ratio (aOR) of 3.6 for preterm birth (95% CI, 1.2-10.6) and 4.1 for small-for-gestational-age births (10th percentile; 95% CI, 1.7-10.1). In contrast, pregnancies that occurred more than 3 years before diagnosis were associated with an aOR of 1.9 for preeclampsia (95% CI, 1.1-3.1) and 1.6 for preterm birth (95% CI, 1.0-2.4).

### Expert Commentary Dr. Sarah Johnson, Professor of Epidemiology at Yale University, commented on the implications of these findings, stating, "The increased risks associated with systemic sclerosis highlight the urgent need for comprehensive maternal care strategies and tailored pre-pregnancy counseling for affected women. The healthcare system must be prepared to address these elevated risks through multidisciplinary approaches."

Similarly, Dr. Michael Thompson, a leading rheumatologist at Johns Hopkins University, emphasized the importance of educating patients about the potential risks associated with pregnancy in the context of systemic sclerosis. "It is crucial for healthcare providers to discuss these risks thoroughly with their patients, particularly those who are first-time mothers, to ensure they are making informed decisions about their reproductive health," he noted.

### Limitations and Future Outlook Despite the significant findings, the study does have limitations, including the absence of data on disease activity, specific serologic patterns, and treatment regimens for systemic sclerosis. As the authors noted, "Further research is needed to explore the underlying mechanisms contributing to these adverse outcomes and to develop effective management strategies for pregnant women with systemic sclerosis."

As systemic sclerosis continues to be a challenging condition for reproductive health, the findings from this study underscore the necessity for healthcare providers to adopt a proactive stance in managing pregnancies in women with this disease. This research not only contributes to the existing literature but also paves the way for future investigations aimed at improving outcomes for women with systemic sclerosis. As the medical community becomes increasingly aware of these challenges, it is hoped that enhanced care protocols will significantly mitigate the risks associated with pregnancy in this vulnerable population.