REPRODUCTIVE FUNCTION PRIOR TO DISEASE ONSET IN WOMEN WITH SCLERODERMA

We tested in a retrospective study the hypothesis that women with scleroderma have an increased risk, before disease presentation, of problems in pregnancy. Reproductive history, as reported from a validated postal questionnaire, was obtained from 204 women with scleroderma [mean year of birth (yob) 1942] and compared to that reported by 233 women with primary Raynaud's phenomenon (mean yob 1948) and 189 healthy women from a population register (mean yob 1950). Only pregnancies occurring before symptom onset in the scleroderma group were considered for analysis. All analyses were adjusted for job, social class, age at first pregnancy, smoking habit, and where relevant, parity. The results are expressed as odds ratios (OR) [with 95% confidence limits (CL)] giving the risk of developing scleroderma, with previous exposure to each of the specific reproductive variables analyzed, relative to the 2 comparison groups. The women with scleroderma were more likely than the population women to have had a delay in conception (greater-than-or-equal-to 12 months): OR 2.6 (1.1, 5.7) or be infertile: OR 2.3 (0.7, 7.2). These differences were not apparent when the scleroderma group was compared to the women with Raynaud's: OR's 0.7 and 1.1, respectively. Similarly there was a greater self report of maternal ill health in pregnancy in the group with scleroderma compared to the population women: OR 2.1 (1.2, 3.5) but not compared to the women with Raynaud's: OR 1.0 (0.7, 1.6). There were no differences in early fetal loss between the 3 groups but there were more perinatal losses in the scleroderma group than either the population women: OR 3.0 (0.4, 21.1) or the women with Raynaud's: OR 3.6 (0.7, -18.5). The women with scleroderma had a greater proportion of live births of low birth weight than both the women with Raynaud's: OR 1.6 (0.8, 3.2) and the population women OR 2.9 (0.95, 8.7). Our data are consistent with there being an increased rate of problems with reproduction before the clinical onset of scleroderma in women though some of these findings are seen in women with apparent primary Raynaud's phenomenon.