Pregnancy loss, low fertility rates more common in women with psoriasis

Key takeaways:

• Pregnant women with psoriasis had a higher risk for pregnancy loss compared with controls (OR = 1.06).
• Women with moderate to severe psoriasis exhibited lower fertility rates (rate ratio = 0.75).

Women with vs. without psoriasis are at an increased risk for pregnancy loss, and women with moderate to severe psoriasis may also experience lower fertility rates, according to a study.

“Inflammatory and autoimmune diseases have been associated with negative pregnancy outcomes,” Teng-Chou Chen, PhD, of the center for pharmacoepidemiology and drug safety, division of pharmacy and optometry, school of health sciences, faculty of biology, medicine and health, The University of Manchester, and colleagues wrote. “When coinciding with the peak reproductive period, a diagnosis of psoriasis could affect childbearing potential.”

In this population-based cohort study, researchers investigated the fertility rates and pregnancy outcomes of women with psoriasis compared with healthy controls. The study included 63,681 women with psoriasis and 318,405 controls with a median age of 30 years.

Results showed that women with psoriasis actually experienced higher rates of fertility (rate ratio [RR] = 1.3; 95% CI, 1.27-1.33) compared with controls. However, after stratification based on disease severity, women with moderate to severe psoriasis exhibited lower fertility rates (RR = 0.75; 95% CI, 0.69-0.83) compared with healthy controls.

Women with psoriasis that were pregnant had a higher risk for pregnancy loss compared with controls (OR = 1.06; 95% CI, 1.03-1.1). This loss occurred at a gestation period shorter than 91 days in 95% of pregnancy loss cases.

Pregnancies in patients with psoriasis were also less likely to end in live birth (OR = 0.91; 95% CI, 0.88-0.93). On the other hand, there was no statistical difference in stillbirth and preterm birth rates between the groups.

After adjusting for cofounding factors, pregnant women with psoriasis were not at an increased risk for venous thromboembolism, antenatal hemorrhage, preeclampsia, gestational hypertension, gestational diabetes or cesarean delivery.

Overall, the fertility rates of patients with psoriasis followed national fertility trends except when patients developed moderate to severe psoriasis. Most importantly, pregnancy loss was found to be most common in patients with psoriasis.

“To avoid miscarriage and its adverse consequences, further studies should evaluate the effects of better management of psoriasis and close monitoring during pregnancy on pregnancy loss,” the authors concluded.