Systemic sclerosis (SSc), primary pulmonary hypertension (PPH), and sickle cell disease (SCD) are uncommon vasculopathic diseases affecting women. We estimated the nationwide occurrence of pregnancies in women with these conditions and compared pregnancy outcomes to the general obstetric population.
We studied the 2002–2004 Nationwide Inpatient Sample (NIS), of the Healthcare Cost and Utilization Project to estimate the number of obstetric hospitalizations and deliveries among women with SSc, PPH, SCD, and the general population. Pregnancy outcomes included length of hospital stay (LOS), hypertensive disorders including preeclampsia (HTN), intrauterine growth restriction (IUGR), and cesarean delivery. Multivariable regression analyses were performed using maternal age, race/ethnicity, antiphospholipid antibody syndrome, diabetes mellitus, and renal failure as covariates.
Of an estimated 11.2 million deliveries, 504 occurred in women with SSc, 182 with PPH, and 4,352 with SCD. SSc was associated with an increased risk of HTN (OR 3.71, 95%CI 2.25–6.15), IUGR (OR 3.74, 95%CI 1.51–9.28), and increased LOS. PPH was associated with an increase in the odds of antenatal hospitalization (OR 4.67, 95%CI 2.88–7.57), HTN (OR5.62, 95%CI 2.60–12.15) and a substantial increase in LOS. SCD was associated with an increased odds of antenatal hospitalization (OR 5.55, 95%CI 5.08–6.09), HTN (OR 1.78, 95%CI 1.48–2.14), and IUGR (OR 2.91, 95% CI 2.16–3.93), with a modest increase in LOS.
Women with SSc, PPH, and SCD have significantly increased rates of adverse pregnancy outcomes, requiring extensive preconceptional counseling about the risks of pregnancy. All pregnancies should be monitored closely for the development of complications.