Worsening of atopic dermatitis (AD) during pregnancy is uncommon but may be associated with premenstrual syndrome (PMS), study data published in the Journal of the American Academy of Dermatology suggests.
Research suggests that changes in estrogen and progesterone levels—such as those induced by pregnancy—may precipitate worsening AD symptoms. To address this hypothesis, investigators conducted a cross-sectional study at an academic dermatology clinic in Illinois. Adult women (18 years and older) with a diagnosis of AD were recruited from 2016 to 2019. Enrollees were asked to complete electronic questionnaires that captured demographic data, comorbid medical conditions, pregnancy history, and AD symptoms and severity. As the primary outcome, patients were asked if they experienced AD worsening during pregnancy. Multivariable logistic regression models were used to identify correlates of AD worsening during pregnancy.
The study cohort comprised 211 women with AD, among whom 32.2% reported a prior pregnancy. Among patients with pregnancy history, 17.7% indicated that they experienced AD worsening while pregnant. Worsening of AD severity during pregnancy was more common in patients with PMS compared with patients without PMS (72.7% vs 32.7%; P =.019). In multivariable models, AD worsening during pregnancy was not associated with baseline AD severity. AD worsening was also not predicted by any clinical comorbidities or demographic features.
However, the cross-sectional design and single study center limit the generalizability of these findings.
Results from this study challenge research which estimates that AD worsening may occur in over half of pregnancies, the study authors acknowledged. In the current cohort, the prevalence of worsening was just 17% which the researchers wrote “is not trivial.”
Links between PMS with increased premenstrual AD flares are important to women with AD who are family planning, it was noted. Further research is necessary to identify means of mitigating AD during pregnancy.
Rakita U, Kaundinya T, Silverberg JI. Lack of association between atopic dermatitis severity and worsening during pregnancy: a cross-sectional study. J Am Acad Dermatol. Published online October 7, 2021. doi: 10.1016/j.jaad.2021.09.066