Background/Purpose: While there is some evidence that women with psoriasis (Pso) and psoriatic arthritis (PsA) are at increased risk of various comorbidities, this has not been well described in pregnancy.  In addition, there are limited data on the risks of adverse pregnancy outcomes in women with these conditions.  

Methods: Individuals were selected (enrolled 2005-2015) from the Organization of Teratology Information Specialists (OTIS) Autoimmune Diseases in Pregnancy project, a North American prospective cohort study of pregnancy outcome. The ÒexposedÓ were defined as women with singleton live births and PsA (with or without Pso) or psoriasis (Pso) alone. ÒUnexposedÓ were non-diseased pregnant women without exposure to known human teratogens or underlying chronic conditions. The outcomes of interest were baseline differences among the three groups (PsA, Pso, unexposed) and maternal comorbidities. As a secondary objective, we compared selected adverse birth outcomes in the exposed (PsA/Pso) and unexposed groups.   

Results:  A total of 180 exposed women were identified (91 with PsA and 89 with Pso alone). These were compared to 379 non-diseased unexposed women. Except for greater use of biologics in women with PsA, there were no baseline differences between women with PsA and Pso. However, compared to the unexposed group, the PsA/Pso women had a higher prevalence of unplanned pregnancies, pre-pregnancy overweight or obesity, smoking, and illicit drug use. Moreover, compared to the unexposed, Pso/PsA women had higher rates of pre-existing depression (19.4% vs. 9.4%) and hypertension (6.7% vs. 2.1%) (Table 1). In terms of pregnancy outcomes, there were no differences comparing women with PsA to those with Pso. However, pregnant women with either PsA or Pso were at increased risk for cesarean section (RR 1.42 (95% CI 1.10,1.83)) and preterm birth (RR 1.81 (95% CI 1.02,3.23)) compared to the unexposed (Table 2). There was no increased risk for preeclampsia/pregnancy-induced hypertension or small for gestational age infants in exposed.

Conclusion: In this prospective study, pregnant women with PsA (with or without Pso) and Pso alone were similar in their baseline demographics, comorbidities and frequency of adverse pregnancy outcomes. However, compared to healthy controls, PsA/Pso women had more risk factors for adverse pregnancy outcomes (tobacco use, increased pre-pregnancy BMI, and pre-existing depression and hypertension). After adjusting for covariates, PsA/Pso women had increased risks for cesarean section delivery and preterm birth compared to healthy controls.