Pregnancy outcomes in women with moderate-to-severe psoriasis

1. Pregnant women using biologic treatments for psoriasis, both before and during pregnancy, were found to have similar pregnancy outcomes as the general American population.

Evidence Rating Level: 2 (Good)

Psoriasis is a chronic inflammatory skin disease affecting 7 million adults in the United States. It has been hypothesized that the chronic inflammatory state and association with psoriasis-related comorbid conditions such as diabetes and cardiovascular predispose pregnant women to complications. However, there is limited data due to exclusion of pregnant patients from clinical trials, and because psoriasis patients often stop treatment during pregnancy. The current prospective cohort study analyzed the fertility rate and pregnancy outcomes from patients in a longitudinal registry who were eligible for systemic and biologic therapies for their psoriasis. Out of 2,224 women of childbearing age (18-45 years) in the registry, there were 298 pregnancies from 220 patients between 2007 and 2019 (12,929 patient years). The fertility rate was 18.9 per 1000 women, which was lower than the general US population (59.1 per 1000 women). Out of the 298 pregnancies, there were 244 births including 1 stillborn (81.9%), 41 spontaneous abortions (13.8%), and 13 terminations (4.4%). 90.9% of live-births were full-term and 9.1% were premature. 94.7% of newborns were considered healthy, 10 infants (4.1%) had a neonatal issue, and 2 (0.8%) had congenital anomalies. As well, 252 of these pregnancies were in women exposed to biologic therapy both before or during pregnancy. The remaining 46 pregnant women may have received a non-biologic therapy, such as phototherapy, before or during pregnancy. The infants with congenital anomalies were from women who received the biologic ustekinumab, 1 outside of the prenatal period and 1 during. Overall, the pregnancy outcomes in terms of live-born infants, spontaneous abortions, terminations, and congenital abnormalities, are not significantly different from between the general US population and women using biologic treatments for psoriasis, although further studies using pregnancy-specific registries may be needed to increase the sample size.

Click to read the study in JAMA Dermatology

Image: PD

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