Systemic Sclerosis and Abortion: Determining Factors and Clinical Significance in a Multicenter Study

The aim of this work was to identify disease-related factors associated with a history of spontaneous abortion in adult female patients with systemic sclerosis (SSc), and to further analyze the distinguishing features of SSc patients with recurrent versus single abortion episodes.

This multicenter case-control study was extracted from a nationwide SSc cohort of 1,080 patients. Ninety-one female adult SSc patients (8.4%) with a history of spontaneous abortion before 20 completed weeks of gestation were compared with 91 age-matched female SSc patients without a history of spontaneous abortion. Clinical characteristics, comorbidities, organ involvement, medications, and laboratory parameters were analyzed.

Patients with spontaneous abortion had significantly longer disease duration (6.4±4.7 vs. 4.6±4.2 years; p=0.007), a higher prevalence of comorbidities (29.7% vs. 15.4%; p=0.03), more frequent telangiectasia (28.6% vs. 12.1%; p=0.009) and a higher frequency of mycophenolate mofetil use (29.7% vs. 15.4%; p=0.03) compared with patients without a history of spontaneous abortion. Recurrent spontaneous abortion occurred in 30 patients (33.0%). Compared with those with a single spontaneous abortion, patients with recurrent spontaneous abortion had significantly higher frequencies of Raynaud’s phenomenon (p<0.0001), hand puffiness (p=0.047), hypo-/hyperpigmentation (p=0.03), cardiovascular involvement (p=0.046), anti-Scl-70 positivity (p=0.01), double autoantibody positivity (p=0.017), and higher serum triglyceride levels (p=0.006).

Patients with SSc have a higher risk of spontaneous abortion than the general population; this risk is likely driven by decidual vasculopathy and fibrosis. Factors contributing to spontaneous abortion were variable in previous reports, with hypertension and long disease duration among the most contributing factors.

In women with SSc, spontaneous abortion is associated with longer disease duration, telangiectasia, higher serum creatinine levels, the presence of comorbidities, and the use of MMF. Recurrent spontaneous abortion is associated with anti-Scl-70 positivity, double autoantibody positivity, and hypertriglyceridemia.