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35 Systemic sclerosis and reproductive history

Purpose of study Parity affects risk of some autoimmune diseases. Since parity could also affect clinical features, we investigated clinical aspects of systemic sclerosis (SSc) in women according to parity (nulliparous vs parous). Because women harbour cells from pregnancy decades later, we also asked whether the HLA genotype of children born before onset was associated with SSc development in parous women. Methods used Women with SSc were recruited from Washington and surrounding states with some also identified through a national SSc registry. 213 women were evaluated for clinical aspects of SSc according to parity status: 111 parous and 102 nulliparous. HLA-genotyping was conducted from blood or buccal samples using standard methods for parous SSc women and all children born prior to disease onset. Healthy women recruited from Washington State and their children were HLA-genotyped. Analysis was conducted for SSc-associated HLA risk and protective alleles of children comparing women with SSc to healthy women for Caucasians, 93 and 236 respectively. Mantel-Haenszel stratified categorical analysis was the primary statistical method used. Summary of results Parous women had a later age of SSc onset compared to nulliparous women (median=42 years vs 31 years respectively). The time since last birth was shorter for women with diffuse SSc than limited SSc (an average of 13.6 vs 19.6 years, p=0.03). History of an abortion prior to SSc onset was associated with diffuse disease (p<0.001). Parity was not associated with other clinical variables evaluated, including autoantibodies. The mother’s SSc status was not associated with SSc risk or protective alleles in children born prior to SSc onset (paternally-transmitted). Conclusions Clinical aspects of SSc in women differ according to parity and gravidity status. Shorter time from last birth and history of abortion was associated with diffuse disease. The presence of SSc risk or protective alleles in children does not appear to affect disease risk for the mother.