LAUSR

It gives us great pleasure that our article [1] has piqued interest among Barilaro et al. [2] We read the correspondence “Obstetric outcomes in systemic sclerosis: looking inside the sealed box” with great interest. In response to the first query, all the patients who were interviewed sent their details over WhatsApp/email. The strategy of data collection over phone was the most appropriate strategy during a raging worldwide pandemic [3–6]. This is a known age-old method for data collection that we claim no novelty to. However, this is the first study comparing obstetric outcomes between systemic sclerosis, lupus, and Takayasu arteritis with a specific focus on the Indian region. Unfortunately, with a limited number of 15 pregnancies occurring after the onset of systemic sclerosis, matching was not prudent for age or other clinical variables. We did, however, compare outcomes with a large cohort of women in whom pregnancies occurred before the onset of systemic sclerosis, that was the closest available comparison group. Indeed, the small number of pregnancies after scleroderma disease onset deters us from drawing large conclusions or use robust statistics. We hope that large prospective multi-center studies like (International Multicentric Study on PREgnancy in Systemic Sclerosis, IMPRESS [7]) provide further insight into the obstetric outcomes in systemic sclerosis. Ours was an observational study with limitations inherent to a retrospective and interview-based study design [8, 9]. The methodology adopted for evaluating such a retrospective data during the pandemic time, was appropriate according to us. A prospective study is always preceded by a retrospective data analysis, which is in turn preceded by a clinic-based observation [10]. We are reminded of the quote “Learn to walk before you run” in this reference [11]. While we have not answered whether the Schrodinger’s cat is alive or dead, the focus has been on the box and the cat, without ignoring the issue at hand.