Women with psoriasis are less likely to conceive and have a higher risk of pregnancy loss, research suggests.
Psoriasis may affect the odds of conceiving and increase the risk of adverse pregnancy outcomes, a new study suggests.
Experts told Rheumatology Republic the study indicates that women hoping to conceive need specialist antenatal care and to watch for other factors known to reduce fertility.
The UK researchers analysed data from more than 13,000 pregnancies in women aged 15 to 44 with psoriasis and compared them with more than 52,000 matched comparators without psoriasis.
They found that women with moderate to severe psoriasis were almost 20% less likely to have a pregnancy ending in a live birth compared with their peers without psoriasis, after adjusting for confounding factors (aOR=0.82; 95%CI 0.70-0.97, p=0.02).
Overall, women with psoriasis had a 6% higher risk of pregnancy loss, and almost all of those losses occurred in the first trimester.
While women with psoriasis had higher rates of fertility compared with controls (rate ratio [RR]=1.3; 95% CI, 1.27-1.33), when stratified on disease severity researchers found that women with moderate to severe psoriasis had a lower fertility rate (RR=0.75; 95% CI, 0.69-0.83) compared to healthy controls.
There were no statistically significant differences in the risks of stillbirth and preterm birth between patients with moderate to severe psoriasis and matched peers after adjusting for demographics, lifestyle factors, socioeconomic status and comorbidities.
The researchers also said there were no statistically significant differences in the risks of antenatal haemorrhage, preeclampsia, gestational hypertension, gestational diabetes and caesarean delivery between the two groups.
“To avoid miscarriage and its adverse consequences, further studies should evaluate the effects of better management of psoriasis and close monitoring during pregnancy on pregnancy loss,” the researchers wrote in JAMA Dermatology.
“In particular, patients with psoriasis were more likely to have comorbidities that may be related to poor pregnancy outcomes, and hence increased emphasis of managing comorbidities as part of the routine management plan is also warranted.”
Commenting on the study, Canberra-based dermatologist Dr Diana Rubel said possible causes for the link were proinflammatory cytokines and the impact on endothelial cells leading to systemic and placental vasculopathy, which she said was a pathway common to other inflammatory and autoimmune diseases.
“The social stigmatisation of a chronic, visually disruptive condition, comorbidities, and need to avoid pregnancy whilst on certain medications such as methotrexate may also contribute to reduced fertility rates,” she told Rheumatology Republic.
“This is something that we might need to consider reminding our younger female patients. Also, dermatologists should be mindful of addressing comorbidities such as smoking, metabolic syndrome, hypertension and alcohol consumption.”
Dr Rubel said more studies were needed, particularly where early intervention in psoriatic disease might improve fertility and pregnancy outcomes.
Clinical Associate Professor Kurt Gebauer said previous research had shown that severe psoriasis was associated with cancer, arthritis, hypertension, heart disease and adverse pregnancy outcomes.
“Chronic inflammation will make you less fertile,” said Professor Gebauer, a Perth-based dermatologist.
Professor Gebauer said fetal outcomes could also be lower in women with severe psoriasis, particularly if patients were untreated: “People who are effectively treated will do better.”
Professor Gebauer said when seeing a new female patient, he would usually raise the issue of family planning in the first couple of consultations, and tailor medication accordingly.
Pre-pregnancy counselling can also be helpful for women with severe psoriasis, particularly for women who have had previous pregnancy losses, he said.
