Pregnant women with psoriasis at greater risk for cardiovascular complications at delivery

Key takeaways:

• Compared with pregnant patients without psoriasis, those with psoriasis were 1.25 times more likely to have preeclampsia or eclampsia.
• They were also 1.44 times more likely to have cardiac arrhythmias.

Pregnant patients with psoriasis hospitalized for delivery have a higher risk for preeclampsia, cardiac arrhythmias and other cardiovascular complications, according to a study.

“Of importance for reproductive-age women, psoriasis is an independent predictor for maternal cardiovascular complications,” Ankit Agrawal, MD, an internist in the department of cardiovascular medicine in the Heart, Vascular & Thoracic Institute at Cleveland Clinic, and colleagues wrote. “A systematic review and meta-analysis by Rahmati [and colleagues] demonstrated significant associations between maternal psoriasis and increased risks of preeclampsia, gestational diabetes, gestational hypertension, cesarean delivery and preterm birth.”

In this study, the authors evaluated the risk for cardiovascular events during delivery hospitalizations among pregnant patients with psoriasis. Using the National Inpatient Sample to identify hospitalizations for delivery from 2011 to 2020, the authors included 37,482,206 women aged 18 years and older that were hospitalized following delivery, 23,588 of which had psoriasis.

Results showed that pregnant patients with psoriasis were slightly older (30.75 vs. 28.76; P < .001), had a higher likelihood of multiple gestations (2.44% vs. 1.99%; P = .027), had a smoking history (13.22% vs. 5.32%; P < .001) and were less likely to deliver via cesarean section (39.03% vs. 47.22%) compared with controls.

White patients (67.14% vs. 49.94%; P < .001) had a greater psoriasis prevalence vs. Black patients (4.9% vs. 14.06%; P < .001). Pre-pregnancy hypertension (1.09% vs. 0.44%; P < .001), diabetes mellitus (3.04% vs 1.08%; P < .001), hyperlipidemia (1.03% vs. 0.21%; P < .001), obesity (18.73% vs. 8.91%; P < .001), chronic kidney disease (0.35% vs. 0.08%; P < .001) and coronary artery disease (0.1% vs. 0.03%; P = .003) were also more prevalent among women with vs. without psoriasis.

Compared with pregnant patients without psoriasis, those with psoriasis experienced higher rates of preeclampsia and eclampsia (3.49% vs. 5.46%; P < .001), acute kidney injury (0.083% vs. 0.21%; P = .002), cardiac arrhythmias (0.88% vs. 1.45%; P < .001) and venous thromboembolism (0.055% vs. 0.15%, P = .006).

According to a propensity-matched analysis, patients with vs. without psoriasis were 1.25 (95% CI, 1.08-1.43) times more likely to have preeclampsia or eclampsia 1.44 (95% CI, 1.08-1.93) times more likely to have cardiac arrhythmias.

“Our study emphasizes the extent of cardiovascular complications, which may be unknown, in pregnant patients with psoriasis, affecting the outcomes during delivery,” the authors wrote. “These findings highlight the need to ensure cardiovascular screening, prevention of comorbidities, and being watchful for a wide range of cardiovascular complications during delivery and the peripartum period, especially given the rising trend of delivery hospitalizations in this patient population in the last decade.”