Adverse pregnancy and birth outcomes higher in psoriasis

Gestational diabetes, gestational hypertension and pre-eclampsia are higher in women with psoriasis or psoriatic arthritis. (©HaveANiceDayPhoto/Shutterstock.com)

Psoriasis and psoriatic arthritis put pregnant women at an increased risk for adverse pregnancy and birth outcomes, according to recently published research.

Findings from a study in Advances in Dermatology and Venereology revealed women of reproductive age who also have psoriasis or psoriatic arthritis are more likely to develop gestational diabetes, gestational hypertension, and pre-eclampsia. They also have elective or emergency caesarean deliveries more often, and they are at higher risk for preterm birth or low birth weight.

According to study authors, many of these correlations have never before been reported. In some instances, they wrote, unhealthy lifestyles choices already prevalent among women with psoriasis and psoriatic arthritis could contribute to the negative pregnancy and birth outcomes.

THE STUDY

The study, conducted in Sweden and Denmark, gathered data on single-child births between April 2007 and December 2012 that were recorded in national birth registries. Some women gave birth more than once, and each birth was counted individually. Researchers focused on assessing how maternal psoriasis and its severity affected pregnancy and birth outcomes.

During the time period analyzed, 741,973 women gave birth 952,907 times. Of those pregnancies, 8,097 (0.9 percent) occurred in 6,103 women with diagnosed psoriasis, and 312 (4 percent) of that group were categorized as having severe psoriasis. An additional 964 pregnancies (11 percent) occurred in 753 pregnant women who were identified as having psoriatic arthritis.

Based on demographic data, the women with psoriasis and psoriatic arthritis were older (above age 30) and had a high pre-pregnancy body mass index (above 25.0). Data revealed women with severe psoriasis and severe psoriatic arthritis were smokers, approximately 14 percent and 25 percent, respectively. They also had more frequent diagnoses of diabetes, hypertension, and depression than women without psoriasis.

Study analysis showed, when adjusted for maternal age, parity, and country, pregnant women with psoriasis had an increased risk for gestational diabetes (aOR 1.36, 95% CI 1.18-1.57), gestational hypertension (aOR 1.26, 95% CI 1.10-1.44), and pre-eclampsia (aOR 1.28, 95% CI 1.14-1.44). Their elective caesarean section risk was also elevated (aOR 1.17, 95% CI 1.08-1.26), as was their risk for emergency caesarean section (aOR 1.16, 95% CI 1.08-1.26).

When researchers further adjusted for smoking, body mass index, hypertension, diabetes, and depression in women with psoriasis, they, again, found an increased risk of gestational diabetes (aOR 1.20, 95% CI 1.02-1.40), gestational hypertension (aOR 1.17, 95% CI 1.02-1.35), and pre-eclampsia (aOR 1.15, 95% CI 1.01-1.30). Risk was also greater for elective caesarean section (aOR 1.11, 95% CI 1.02-1.20), as well as emergency caesarean section (aOR 1.09, 95% CI 1.01-1.18).

Women with severe psoriasis were also more likely to experience moderate preterm birth (aOR 1.64, 95% CI 1.03-2.61), as well as low birth weight (aOR 1.81, 95% CI 1.14-2.89).

While children born to women with psoriasis did have a higher Apgar score than those born to women without psoriasis, they did not face a higher risk of antepartum hemorrhage, venous thromboembolism, being small for gestational age, stillbirth, or major congenital malformations.

Among women with psoriatic arthritis, researchers identified an increased risk of gestational hypertension (aOR 1.60, 95% CI 1.13-2.29), pre-eclampsia (aOR 1.49, 95% CI 1.08-2.05), and elective caesarean section (aOR 1.49, 95% CI 1.18-1.81).

However, the authors acknowledge that some modifiable lifestyle factors could contribute to the increased risks of negative pregnancy and birth outcomes among these women. Obesity, diabetes, hypertension, and depression are commonly reported among women with severe psoriasis and psoriatic arthritis. Those conditions have also been previously, and independently, linked to adverse pregnancy and birth outcomes.

“The attenuation of the risks, when adjusting for these conditions, indicate that lifestyle changes may potentially reduce risks of adverse pregnancy and birth outcomes,” the authors wrote.

The study had both strengths and weaknesses, they added. The size and population-based design enabled researchers to examine multiple and rare outcomes and limit selection bias. However, because the data were not collected strictly for research purposes, it’s possible that some misclassification of participants could exist. Any impact, though, they indicated, would be minuscule. Additionally, using drug treatment and psoriatic arthritis diagnosis as a proxy for identifying severe disease could have created the small change some women with severe psoriasis were incorrectly classified as non-severe.

Ultimately, the authors wrote, women with psoriasis and psoriatic arthritis should take steps to limit any outside factors that could augment their already elevated risk for pregnancy and birth complications. That includes changing any unhealthy, controllable behaviors.

“Modifiable lifestyle factors should be addressed in women with psoriasis who are of childbearing age,” they wrote.

REFERENCE
Berglind A, Broms G, Haerskjold A, Kieler H, Pedersen L, Effect of Maternal Psoriasis on Pregnancy and Birth Outcomes: A Population-based Cohort Study from Denmark and Sweden, Advances in Dermatology and Venereology (2018); doi: 10.2340/00015555-2923.