From limited studies, scleroderma may slightly decrease fertility, but these effects are small, if they exist at all. The disease may also carry a slightly increased chance of miscarriage.
In the past, many doctors recommended that women with scleroderma avoid pregnancy, as it was thought to entail a high risk for both mother and baby. In light of more recent studies, however, most physicians agree that most women with scleroderma can have successful pregnancies if they plan carefully and are carefully monitored and treated. Women with scleroderma do show an increased rate of preterm births and smaller full term infants compared to mothers without the condition. Specialized prenatal care can help diminish these risks, and specialized neonatal care can help bring about positive long-term outcomes. In general, the risks appear to be greater for those with long-standing diffuse scleroderma as opposed to those with localized scleroderma.
The greatest risk is renal crisis, characterized by a marked sudden increase in blood pressure and potential kidney failure, which is life threatening for both mother and child. If this occurs, these patients need to be treated with ACE inhibitor drugs (such as captopril). Though these drugs are usually avoided during pregnancy due to risks to the fetus, they may be needed in this crisis situation. This marked increase in blood pressure is more common in patients with diffuse scleroderma, and also in patients who are within five years of their onset of symptoms.
Certain women with scleroderma should probably avoid becoming pregnant due to health risks, for example, women with severely elevated blood pressure in the lungs, severe lung disease, severe kidney disease, or severe heart involvement. These women may want to consider other options for expanding their family.
Include your doctor in your pre-pregnancy planning. Find out if the severity of your scleroderma makes pregnancy advisable. For the best outcome for mother and baby, pregnancy should be planned for a time when the disease is stable, not when it is escalating, so ask your doctor’s advice about a good time to conceive, and work together to get your symptoms under control.
Women with a history of kidney failure due to increased blood pressure can still have successful pregnancies, but these patients should be stable at the time of conception. You may need to change some of your medications if you are trying to conceive, both for fertility reasons and due to risk of birth defects.
Talk carefully with your doctor about medication risks and benefits before you conceive and during your pregnancy. For example, the drug cyclophosphamide increases the risk of congenital abnormalities in the first trimester. Different drugs may pose more risks at certain times of the pregnancy; a drug might have a favorable risk/benefit profile at a certain stage in pregnancy, but not in others.
Women with scleroderma will require more frequent monitoring during their pregnancies. In some cases, your doctor may advise a planned preterm delivery if your disease requires aggressive treatment that might be harmful to your baby.
Many symptoms associated with scleroderma decrease during pregnancy. In particular, symptoms of Raynaud’s syndrome (very pale, numb, or painful fingers) decrease. Symptoms of heartburn worsen in many patients, but this is a normal pregnancy symptom. After pregnancy, many women with diffuse scleroderma notice increased skin thickening.
About the Author
Ruth J. Hickman, MD, is a freelance health, science, and medical writer. She specializes in writing about medical topics for the lay public and for health science students. She can be reached at [email protected] or through her website: ruthjhickmanmd.com.
This blog post was originally published by AutoimmuneMom.com, written by Ruth J. Hickman, MD, and first published on Jul 25, 2013.