A&R：系统性硬化症患者早产风险高

意大利布雷西亚大学和民用医院的Mara Taraborelli进行了一项多中心研究，该研究目的是评价女性系统性硬化症（SSc）患者的胎儿和产妇状况。研究结果在线发布在2012年6月的《关节炎与风湿病》（ARTHRITIS & RHEUMATISM）杂志上，作者发现，女性SSc患者能有成功妊娠，但是她们发生早产、胎儿宫内生长受限和极低体重儿的风险高于一般产妇。妊娠过程中或者妊娠结束后病情进展罕见。这些患者需要多科室共同管理。而严重器官损伤的女性患者应避免怀孕，新近发病的SSc患者需要推迟怀孕，尤其是抗-Scl-70阳性的女性患者。

研究者对前期收集的99位女性SSc患者的数据进行回顾性分析。受试者来自意大利的25个研究中心。入选患者在2000至2011年期间共怀孕109次，对照组是产科的一般产妇（总共3,939次生产）。妊娠时产妇年龄的均数±标准差是31.8±5.3年，产妇的平均妊娠期是60个月（范围是2-193个月）。

研究结果如下，与产科的一般产妇相比，SSc患者的早产（25% vs 12%）、严重早产（<34孕周）（10% vs 5%）、胎儿宫内生长受限（6% vs 10%）和极低出生体重儿（5% vs 1%）的概率显著升高。多因素分析的结果显示皮质醇的使用与早产相关（风险比[OR]：3.63,95%可信区间[95%CI]:1.12-11.78）；然而，叶酸的使用（OR:0.30，95%CI：0.10-0.91）和抗Scl-70抗体的出现（OR:0.26，95%CI:0.008-0.85）是保护因素。绝大多数SSc患者生产后病情稳定，但是4例在生产后的1年内出现病情进展。在所有抗-Scl-70抗体阳性的女性中，有3位在3年内出现病情持续活动。

研究发现，女性SSc患者能有成功妊娠，但是她们发生早产、胎儿宫内生长受限和极低体重儿的风险高于一般产妇。妊娠过程中或者妊娠结束后病情进展罕见，但也有可能发生。这些患者需要多科室共同管理，而严重器官损伤的女性患者应避免怀孕，新近发生的SSc患者需要推迟怀孕。

Brief report: successful pregnancies but a higher risk of preterm births in patients with systemic sclerosis: an Italian multicenter study.
OBJECTIVE
To assess fetal and maternal outcomes in women with systemic sclerosis (SSc).
METHODS
Prospectively collected data on 99 women with SSc from 25 Italian centers were analyzed retrospectively. Women with SSc were observed during 109 pregnancies (from 2000 to 2011), and outcomes were compared to those in the general obstetric population (total of 3,939 deliveries). The maternal age at conception was a mean ± SD 31.8 ± 5.3 years, and the median disease duration at conception was 60 months (range 2-193 months).
RESULTS
SSc patients, compared to the general obstetric population, had a significantly increased frequency of preterm deliveries (25% versus 12%) and severe preterm deliveries (<34 weeks of gestation) (10% versus 5%), intrauterine growth restriction (6% versus 1%), and babies with very-low birth weight (5% versus 1%). Results of multivariable analysis showed that corticosteroid use was associated with preterm deliveries (odds ratio [OR] 3.63, 95% confidence interval [95% CI] 1.12-11.78), whereas the use of folic acid (OR 0.30, 95% CI 0.10-0.91) and presence of anti-Scl-70 antibodies (OR 0.26, 95% CI 0.08-0.85) were protective. The disease remained stable in most SSc patients, but there were 4 cases of progression of disease within 1 year from delivery, all in anti-Scl-70 antibody-positive women, 3 of whom had a disease duration of <3 years.
CONCLUSION
Women with SSc can have successful pregnancies, but they have a higher-than-normal risk of preterm delivery, intrauterine growth restriction, and babies with very-low birth weight. Progression of the disease during or after pregnancy is rare, but possible. High-risk multidisciplinary management should be standard for these patients, and pregnancy should be avoided in women with severe organ damage and postponed in women with SSc of recent onset, particularly if the patient is positive for anti-Scl-70 antibodies.