Maternal and neonatal outcomes in Pso

Psoriasis is a common auto-immune disease affecting the skin and joints. Current literature regarding psoriasis in the context of pregnancy is limited and contradictory.¹ The Psoriasis Hub previously reported on key findings from a nationwide Danish case-control study investigating the association between psoriasis and adverse pregnancy outcomes in around half a million women.

In order to further evaluate the association between psoriasis in pregnancy and maternal and neonatal outcomes, Krim et al.¹ conducted a population-based study within a cohort of 13 million births. Below, we summarize the key findings.

Methods¹

A population based, retrospective cohort study was conducted using the 1999–2015 United States (U.S.) Healthcare Cost and Utilization Project Nationwide Inpatient Sample, as outlined in Figure 1.

CI, confidence interval; ICD-9-CM, International Classification of Diseases, Ninth Revision, Clinical Modification.
*Adapted from Krim, et al.¹

Initial analysis determined the annual prevalence of psoriasis in pregnancy between 1999 and 2015 and summarized baseline characteristics of psoriasis and non-psoriasis groups. Variables and outcomes of interest included maternal age, race, obesity, smoker status, comorbidities, income, insurance status, and hospital type.

Results¹

• In U.S. hospitals, 13,792,544 pregnancy admissions were identified between 1999 and 2015, inclusively.
  • In this cohort, 3,737 women presented with psoriasis; a period prevalence of 27.1 cases per 100,000 pregnancies.
• The prevalence of psoriasis during pregnancy increased gradually over the duration of the 17-year study, from <10 psoriasis cases per 100,000 admissions in 1999 to >70 per 100,000 in 2015.
• Women with psoriasis tended to
  • be aged >25 years;
  • be of White descent;
  • have a higher median household income;
  • have private insurance;
  • receive care in an urban teaching hospital; and
  • have a higher prevalence of smoking, obesity, and comorbidities including preexisting diabetes and chronic hypertension.

Notable differentiated risk outcomes, summarized in Table 1, were as follows:

• Women with psoriasis had a significantly higher risk of antepartum gestational diabetes and preeclampsia.
• Women with psoriasis had an intra- and post-partum increased risk of chorioamnionitis, cesarean section delivery, anemia, receiving blood transfusions, and a 13-fold increased risk of myocardial infarction.
• Neonates of women with psoriasis had a greater risk of preterm birth, congenital anomalies, and intrauterine growth restriction.

Table 1. Notable differentiated risk outcomes*

CI, confidence interval; OR, odds ratio. *Adapted from Krim, et al.1
Risk outcome, %	No psoriasis (n = 13,788,807)	Psoriasis (n = 3,737)	OR	95% CI	p value
Antepartum
Gestational diabetes	5.75	8.75	1.27	1.13–1.42	<0.0001
Preeclampsia	3.9	6.5	1.4	1.2–1.6	<0.0001
Intrapartum and postpartum
Chorioamnionitis	1.8	2.3	1.3	1.0–1.6	<0.05
Cesarean section delivery	30.2	39.0	1.2	1.1–1.3	<0.0001
Anemia	0.54	0.70	1.74	1.18–2.57	0.01
Receiving blood transfusions	0.8	1.2	1.4	1.0–1.8	<0.05
Myocardial infarction	<0.1	0.1	13.4	3.3–54.6	<0.001
Neonatal
Preterm birth	7.1	8.9	1.2	1.1–1.4	<0.01
Congenital abnormalities	0.4	1.0	1.7	1.2–2.4	<0.01
Intrauterine growth restriction	2.0	3.4	1.5	1.2–1.7	<0.0001

Conclusion¹

These results indicate that women with psoriasis and their newborns are more likely to experience adverse outcomes of pregnancy than the general population. The findings suggest that women with psoriasis would benefit from close monitoring by their obstetrician and dermatologist during pregnancy. Krim et al. conclude that further investigation into psoriasis management during pregnancy is warranted.