{
  "abstract": "Introduction In recent years, increasing evidence has become available on pregnancy outcomes in connective tissue diseases, including systemic sclerosis(SSc). Nevertheless, few data are available regarding the postpartum period, although being characterized by major hormonal changes and physical exhaustion, possibly affecting disease activity.The aim of this study was to evaluate disease course after delivery in patients with SSc and in those fulfilling VEDOSS (Very Early Diagnosis of Systemic Sclerosis) criteria.Material and Methods Retrospective multicentre case-control study, from 4 European centres.Cases: consecutive SSc (2013 ACR/EULAR criteria) or VEDOSS female patients with at least one pregnancy after diagnosis and 12 months follow-up after delivery (postpartum period) available.Controls: 1 or 2 non-pregnant patients for each case, matched for SSc-specific antibodies, cutaneous subset, and disease duration.Disease progression was assessed using predefined criteria (table 1).Results 62 pregnancies in 51 patients were included (41 SSc, 21 VEDOSS)( table 2). Median gestational age was 39 weeks (IQR 37-40). Two preterm (<37W) and two early preterm deliveries (<=34SG) were recorded.Clinical features of SSc patients were compared before (T0, last pre-conception visit) and after pregnancy (T1, 12 months postpartum). For the control group, analogous timepoints (T0 and T1) matched for the same disease duration were considered (table 3).Among 33 SSc patients, 9(27%) experienced disease progression within 12 months postpartum compared with 4/45(9%) in the control group (p=0.062). Progression included new onset(n=3) or worsening of ILD (n=1), new digital ulcers (n=2), new immunosuppressive therapy(n=4), worsening of skin involvement (n=2), and new onset PAH (n=1).Progression occurred at a median of 7 months postpartum (IQR 4–10), with median disease duration of 6 years (IQR 4–11).Additionally, 10/33(30%) SSc patients not meeting progression criteria reported worsening of other manifestations postpartum, versus 7/45 (16%) controls (p=0.166), including dysphagia, digital ulcers, microstomia, pitting scars, joint contractures, arthritis, or new-onset ILD with pFVC>80%.Among VEDOSS patients, 4/18(22%) developed cutaneous involvement in the postpartum period and fulfilled SSc criteria.Conclusions In the 12 months after delivery, 27% of SSc women experienced disease progression (versus 9% of matched non-pregnant controls) and 22% of VEDOSS patients progressed to SSc.Overall, the postpartum period seems to represent a vulnerable window for disease progression for SSc and related conditions, requiring careful monitoring and timely therapeutic adjustments.Acknowledgements: The authors acknowledge GILS (Gruppo Italiano Lotta Sclerodermia) for supporting the scientific projects of the Scleroderma Unit, and the EULAR Reproductive Health and Family Planning Study Group for facilitating the dissemination of this project.Abstract P.365 Table 1Predefined disease progression criteriaAbstract P.365 Table 2Baseline characteristics of 51 patients included in the studyAbstract P.365 Table 3Comparison of clinical characteristics before and after pregnancy in patients with Systemic Sclerosis",
  "authors": [
    {
      "affiliations": [
        "Rheumatology and Clinical Immunology, Scleroderma Unit, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy"
      ],
      "name": "Elda Piovani"
    },
    {
      "affiliations": [
        "Rheumatology and Clinical Immunology, Scleroderma Unit, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy"
      ],
      "name": "Eleonora Pazzi"
    },
    {
      "affiliations": [
        "Rheumatology and Clinical Immunology, Scleroderma Unit, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy"
      ],
      "name": "Liala Moschetti"
    },
    {
      "affiliations": [
        "Rheumatology and Clinical Immunology, Scleroderma Unit, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy"
      ],
      "name": "Claudia Barison"
    },
    {
      "affiliations": [
        "Rheumatology and Clinical Immunology, Scleroderma Unit, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy"
      ],
      "name": "Eleonora Pedretti"
    },
    {
      "affiliations": [
        "Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester, UK",
        "Manchester University NHS Foundation Trust (MFT), Manchester, UK"
      ],
      "name": "Cristiana Sieiro Santos"
    },
    {
      "affiliations": [
        "Rheumatology Department, Unidade Local de Saúde Santa Maria, Lisbon, Portugal"
      ],
      "name": "Carla Martins"
    },
    {
      "affiliations": [
        "Rheumatology and Clinical Immunology, Scleroderma Unit, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy"
      ],
      "name": "Paolo Semeraro"
    },
    {
      "affiliations": [
        "Department of Clinical and Experimental Sciences, Facultu of Medicine and Surgery, University of Brescia, Brescia, Italy"
      ],
      "name": "Luca Ongaro"
    },
    {
      "affiliations": [
        "Marmara Vasculitis Clinic, Division of Rheumatology, Department of Internal Medicine, Marmara University, Istanbul, Turkey"
      ],
      "name": "Fatma Alibaz-Oner"
    },
    {
      "affiliations": [
        "Rheumatology and Clinical Immunology, Scleroderma Unit, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy"
      ],
      "name": "Angela Tincani"
    },
    {
      "affiliations": [
        "Rheumatology and Clinical Immunology, Scleroderma Unit, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy"
      ],
      "name": "Laura Andreoli"
    },
    {
      "affiliations": [
        "Rheumatology and Clinical Immunology, Scleroderma Unit, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy"
      ],
      "name": "Maria Grazia Lazzaroni"
    },
    {
      "affiliations": [
        "Rheumatology and Clinical Immunology, Scleroderma Unit, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy"
      ],
      "name": "Ilaria Cavazzana"
    },
    {
      "affiliations": [
        "Rheumatology and Clinical Immunology, Scleroderma Unit, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy"
      ],
      "name": "Franco Franceschini"
    },
    {
      "affiliations": [
        "Rheumatology and Clinical Immunology, Scleroderma Unit, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy"
      ],
      "name": "Paolo Airò"
    }
  ],
  "title": "P.365 Disease outcome during the postpartum period in systemic sclerosis and VEDOSS patients: a retrospective multicentre study",
  "uid": "7def4101-818f-5930-aeb3-48793b93efd9"
}