Psoriasis and the Possibility of Adverse Pregnancy Outcomes

Back pain in woman concept. Female patient hurt from lower backache from bowel and bladder problems, palvic inflammatory disease (PID) or motherhood pregnancy.
Researchers sought to determine if psoriasis is associated with greater risk of adverse pregnancy outcomes and if psoriasis severity affects the association.

A significant association exists between psoriasis and ectopic pregnancy (EP), indicating that women with psoriasis face greater risk of  EP than women without psoriasis, according to study results published in the Journal of The American Academy of Dermatology International. No association was found between psoriasis and stillbirth, intrauterine fetal death (IUFD), or spontaneous abortion.

About 75% of women with psoriasis  present during possible childbearing years. Studies have linked adverse pregnancy outcomes (APO) with an excess of T helper type 17 (Th17) cells that drive systemic inflammation). Researchers sought to determine if psoriasis is associated with greater risk of APOs and if psoriasis severity affects the association.

To accomplish this, they conducted a nationwide register-based case-control retrospective study in Denmark with data from 1973-2017 collected from the Danish National Patient Registry and the Danish Medical Birth Register. The data  included 42,041 women with APOs (EP, stillbirth, intrauterine fetal death [IUFD], spontaneous abortion), of whom 6225 had mild psoriasis and 201 had moderate-severe psoriasis, and 449,233 women with single live birth as control comparators, all with first-time pregnancy. A sub-analysis was conducted with psoriatic arthritis (PsA) instead of psoriasis as exposure. Severity of psoriasis (mild or moderate-severe) was defined by psoriasis treatment.

The only APO statistically associated with psoriasis was EP (odds ratio [OR], 1.34; 95% CI, 1.06-1.68) with an even higher OR among women with moderate-severe psoriasis (OR, 2.77; 95% CI, 1.13-6.76). Women with moderate-severe psoriasis vs women without psoriasis showed a greater absolute risk of EP (3.98% vs 1.50%), respectively.

Study limitations include lack of data confirming psoriasis severity or confounding lifestyle issues. The nature of the study methodology precludes assigning causality.

Researchers concluded that there is “a significant association between EP and psoriasis,” however, “We found no association between psoriasis or PsA and spontaneous abortion, IUFD, and stillbirth.” They urge women with psoriasis who are of reproductive age to find emergency gynecologic care if they experience unplanned absence of menstruation, lower abdominal pain, or concurrent vaginal bleeding.

Disclosure: Several study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Reference

Johansen CB, Egeberg A, Jimenez-Solem E, Skov L, Thomsen SF. Psoriasis and adverse pregnancy outcomes: A nationwide case-control study in 491,274 women in Denmark. JAAD Int. Published online April 19, 2022. doi:10.1016/j.jdin.2022.03.009