Although dermatologists are highly knowledgeable about recommendations formanaging patients of reproductive age with psoriasis, implementation of some of the recommendations is low, according to study findings published in Actas Dermo-Sifiliográficas.
The findings are based on responses to an online survey regarding a consensus statement of recommendations for improving the management of patients of reproductive age with psoriasis in 2020 from the Psoriasis Working Group (PWG) of the Spanish Academy of Dermatology and Venereology (AEDV). The survey was emailed to members of the PWG from October 1, 2021, to October 31, 2021.
A total of 53 dermatologists responded to the survey—53% were women, 57% were aged 46 to 55 years, 81% worked in a tertiary care hospital, and 79% worked in a dedicated psoriasis unit.
Among the respondents, 96% were familiar with the PWG recommendations, and 5% were part of a multidisciplinary maternity care unit or team. About three-quarters of respondents reported a lack of specific protocols related to psoriasis and pregnancy in their departments, and the use of educational material other than verbal advice and pamphlets, videos, and web-based tools was uncommon. The dermatologists were very knowledgeable about the effects of psoriasis on pregnancy and breastfeeding, as well as the effects of psoriasis treatments (mean scores, 7.70 [1.41] to 8.84 [0.71] on a scale of 1 to 10), it was written.
About 71% of survey respondents stated that they routinely ask their patients about their pregnancy plans, and 46% ask both men and women. Most respondents believed that women should be in remission or have low disease activity before becoming pregnant (74%) and during pregnancy (almost 85%). After their patients had confirmation of pregnancy, the dermatologists most frequently had discussions with the patients about the effects of pregnancy on psoriasis and vice versa (81%) and the assessment of treatment (79%).
The primary factors that affected treatment decisions in pregnant women with psoriasis were disease characteristics (mean, 4.28 [0.85]) and summary of product characteristic information (mean score, 4.21 [0.74]), based on a scale of 1 to 5.
A majority (81%) of respondents recommended breastfeeding and about half monitor children born to mothers exposed to biologic therapies. About 53% of respondents systematically assess for postpartum flare-ups, and 94% return to usual follow-up practices.
The main barriers to implementing the PWG recommendations were lack of time, a lack of robust data from clinical studies especially regarding medication, and a lack of support from health care managers. The main facilitators were improved communication between disciplines, support from nursing staff, and development of educational material.
The researchers noted that because the survey was sent to PWG members, there is a risk of selection bias, as dermatologists who are members of this group may have more interest and experience in the management of psoriasis associated with pregnancy and may be more likely to implement the PWG recommendations. Also, the survey was conducted a year after the recommendations were published online, and more time may be needed for their implementation.
“Variable degrees of implementation of the PWG recommendations on managing psoriasis in relation to fertility, pregnancy, postpartum, breastfeeding, and perinatal care were observed, with high levels largely seen for treatment-related recommendations and lower levels seen for preconception-related recommendations,” the researchers commented. “Continued efforts are needed to improve the implementation of the PWG recommendations, particularly in certain areas.”
Belinchón I, Armesto S, de la Cueva P, Ferrándiz L, Díaz RR, Carrascosa JM. Implementation of recommendations for the management of psoriasis during preconception, pregnancy, postpartum, breastfeeding, and perinatal care. Actas Dermosifiliogr. Published online March 12, 2022. doi:10.1016/j.ad.2022.02.028