In systemic sclerosis, which maternal complication is significantly associated with poor outcomes and is a leading cause of death?

In systemic sclerosis, which maternal complication is significantly associated with poor outcomes and is a leading cause of death?

• A. Pulmonary arterial hypertension
• B. Raynaud's phenomenon alone
• C. Digital ulcers
• D. Esophageal reflux alone

Answer: (A)

Pulmonary arterial hypertension is the factor most linked with poor outcomes and is a leading cause of death in systemic sclerosis, especially during pregnancy. The heart and lungs bear the brunt of pregnancy’s hemodynamic changes—blood volume and cardiac output rise, while pulmonary vascular resistance can worsen in PAH. This combination can precipitate right ventricular failure, hypoxemia, and rapid decompensation, explaining the high maternal mortality risk. Other common scleroderma features like Raynaud’s phenomenon, digital ulcers, or esophageal reflux reflect vascular and GI involvement but do not carry the same level of risk for fatal outcomes in pregnancy.

Pulmonary arterial hypertension is the factor most linked with poor outcomes and is a leading cause of death in systemic sclerosis, especially during pregnancy. The heart and lungs bear the brunt of pregnancy’s hemodynamic changes—blood volume and cardiac output rise, while pulmonary vascular resistance can worsen in PAH. This combination can precipitate right ventricular failure, hypoxemia, and rapid decompensation, explaining the high maternal mortality risk. Other common scleroderma features like Raynaud’s phenomenon, digital ulcers, or esophageal reflux reflect vascular and GI involvement but do not carry the same level of risk for fatal outcomes in pregnancy.