Background/Purpose: Outcomes of pregnancy are well studied in a number of rheumatic diseases such as Rheumatoid Arthritis (RA) and systemic lupus erythematosus. However, there is very limited data in pregnancy outcomes in patients with psoriasis and psoriatic arthritis (PsA). This study was undertaken to determine the frequency of complications occurring during pregnancy for women with psoriasis and/or PsA and to compare these outcomes with the general obstetric population by using the largest inpatient care database. 

Methods: By using the 2003-2011 Nationwide Inpatient Sample of Healthcare Cost and Utilization Project, we estimated the number of obstetric hospitalization, deliveries and caesarean deliveries in women between the age group 18-50 years. Patients hospitalized with psoriasis and/or PsA were identified. Demographic characteristics and in-hospital outcomes were recorded for both psoriasis and/or PsA as well as control group. Subsequently, obstetric complications for all pregnancy-related admissions for women with and without psoriasis and/or PsA were compared. Multivariate logistic regression analysis was used to obtain adjusted odds ratio (OR).

Results: The total number of obstetric hospitalization was 42.32 million, of which 11204 were women with diagnosis of psoriasis and/or PsA. The mean maternal age of this population was higher (30.32 years) than the control group (27.32 years) {p < 0.001}. After adjusting for potential confounders, the results suggest that maternal Psoriasis/PsA population had no significant increase in inpatient mortality or fetal death. Prevalence of preterm delivery, premature rupture of membranes, postpartum hemorrhage and cesarean delivery was also similar among the two groups. Interestingly, the odds of hypertensive diseases in psoriasis/PsA patients was significantly lower. The results do suggest that psoriasis/PsA patients may have a higher risk of intrauterine growth retardation. The frequencies of the above outcomes along with Odds Ratio are provided in Table 1.

Conclusion: Based on our study of national cohort, we conclude that pregnancies in women with psoriasis and PsA are relatively safe without any increase in maternal or fetal mortality despite having a higher maternal age. These data are reassuring that these women also do not have higher risk of adverse outcomes of pregnancy than women without psoriasis and PsA. In contrast, RA patients have worse outcomes based on the same analysis. These findings highlight that psoriasis and PsA patients may have a positive/normal physiologic response to pregnancy than RA patients. We suggest that continued close antenatal and post-delivery monitoring pregnancy be performed until these results are further clarified.