How do you monitor a patient with scleroderma during pregnancy?

One of the most important aspects of monitoring scleroderma patients in pregnancy is the preconception visit to review the stage of the disease including getting cardiopulmonary studies before pregnancy and reviewing medications and adjusting any immunosuppressive medications. Although prospective studies have shown overall good outcomes, mostly increased prematurity, small babies, and possibly increased risk of preeclampsia, the patients should be followed by high-risk pregnancy groups. The patient who is still at high risk for having a renal crisis (an early diffuse cutaneous disease with RNA polymerase III) should be strongly discouraged on getting pregnant at least until her disease has stabilized and it would be safe to switch her to a...