# Reproductive Outcomes and Fertility Patterns in Women with Systemic Sclerosis: A Multicentre Observational Study

## TL;DR

This study examines fertility and pregnancy outcomes in Indian women with systemic sclerosis, finding reduced fertility and higher pregnancy loss, especially with early disease onset.

## Contribution

The study provides novel insights into reproductive patterns and outcomes specific to Indian women with systemic sclerosis.

## Key findings

- Women with SSc had reduced fertility and increased pregnancy loss compared to general population norms.
- Early-onset SSc significantly impacts marital prospects and reproductive potential.
- Post-disease pregnancies were associated with higher caesarean section rates compared to pre-disease pregnancies.

## Abstract

Limited data are available from India to guide patient counselling and management in systemic sclerosis (SSc). This study evaluates reproductive patterns, fertility outcomes, and pregnancy complications before and after SSc onset, comparing married and unmarried women in India.

Data were extracted from the Indian Rheumatology Association registry across seven centres. Female patients meeting ACR/EULAR 2013 criteria for SSc were included. Reproductive history, menstrual patterns, cumulative fertility rate (CFR), pregnancy wastage ratio, stillbirth, and abortion rates were analysed, with comparisons between married and unmarried women, and between pre- and post-disease pregnancies.

Of 183 patients, 131 women were analysed (117 married, 14 unmarried). Married women had later disease onset (37.44 ± 10.57 vs. 19.79 ± 3.69 years; P < 0.001) and more comorbidities (46.15% vs. 14.28%; P = 0.024), while menstrual irregularities were more frequent in unmarried women (28.57% vs. 11.11%). Post-disease pregnancies occurred at younger disease onset (25.44 ± 5.83 vs. 38.08 ± 10.42 years; P < 0.001). Parity, abortion, and live birth rates were similar between pre- and post-disease pregnancies, but vaginal deliveries predominated pre-disease (186 vs. 6), whereas caesarean sections were more frequent post-disease (4/10; P = 0.023). Overall CFR was 1.68, pregnancy wastage ratio 125/1,000 pregnancies, lifetime abortion rate 221.37/1,000 women, and stillbirth rate 30.53/1,000 women.

Women with SSc exhibit reduced fertility and increased pregnancy loss. Early-onset disease affects marital prospects and reproductive potential. Multidisciplinary care with preconception counselling and vigilant pregnancy monitoring is essential to optimise maternal and foetal outcomes.