Women with psoriasis have pregnancy outcomes similar to general population

Women with moderate to severe psoriasis had similar pregnancy outcomes as the general population, according to a study.

Using data from the multicenter, disease-based, observational Psoriasis Longitudinal Assessment and Registry, a cohort study evaluated pregnancy outcomes for 220 women with 298 pregnancies. Demographic and clinical characteristics for all childbearing-aged women were collected, and for those who became pregnant, data regarding births, stillbirths, spontaneous abortions and elective terminations, as well as live-birth characteristics, were collected.

“Roughly 50% of patients with psoriasis are women, and in more than 75% of cases, onset of psoriasis occurs at 40 years or younger (ie, during years of childbearing potential),” Alexa B. Kimball, MD, MPH, of the department of dermatology at Beth Israel Deaconess Medical Center at Harvard Medical School, and colleagues wrote. “Autoimmune inflammation associated with psoriasis and psoriasis-related comorbidities (eg, diabetes, cardiovascular disease and depression) may increase the risk for adverse pregnancy outcomes.”

The study found 244 live births (81.9%) from the 298 pregnancies. Spontaneous abortion occurred in 41 pregnancies (13.8%), and 13 pregnancies (4.4%) were electively terminated.

Of 243 live births with gestational age available, 221 (90.9%) were full term, with 22 (9.1%) premature. Healthy newborns accounted for 231 (94.7%) live births, while 10 (4.1%) had neonatal problems, one (0.4%) was a stillbirth and two (0.8%) had congenital anomalies.

Two hundred fifty-two pregnancies were in women who had been exposed to biologic therapy before or during pregnancy, and 168 pregnancies were exposed during the prenatal period. Women who were never exposed to biologic therapies but received another systemic therapy or phototherapy during pregnancy accounted for 46 pregnancies.

The two congenital anomalies were in infants born to those who received ustekinumab during the prenatal period.

“The observed rate of congenital anomalies (0.8%) was lower than the U.S. annual rate of approximately 3%,” the authors wrote.

“There are multiple ways to treat psoriasis during pregnancy, some safer than others, so women should be reassured about becoming pregnant and also about pursuing treatment during their pregnancy,” Kimball told Healio in an email correspondence. “Rates of spontaneous abortion, fetal abnormalities, and risk of pre-term delivery in pregnancies carried by women with moderate to severe psoriasis are reassuringly similar to the rest of the population.”

Studies from pregnancy-specific registries that include a lot of women with psoriasis are recommended to continue evaluating the association between psoriasis treatment and birth outcomes.

“While data isn’t perfect or complete, it’s clear that there is a pathway to treat women effectively and at low risk during pregnancy,” Kimball said. “Expert opinion from dermatology can help guide those choices in many cases.”