According to research results published in BJOG, a majority of women with psoriatic arthritis (PsA) have uneventful pregnancies. However, data suggest increased risks for preterm births and cesarean deliveries.
Researchers used Swedish national registers from 1997 to 2014 to conduct a nationwide cohort study of pregnancies in women with and without PsA. The goal of the study was to examine disease-specific pregnancy outcomes in the patient population.
Using data from the study period, researchers identified 541 singleton pregnancies in 330 women with PsA and 40,944 pregnancies in 25,594 women without PsA. In the PsA cohort, 7.6% of births were preterm vs 4.9% in the non-PsA cohort (adjusted odds ratio [aOR] 1.63; 95% CI, 1.17-2.28); women with PsA were at an increased risk for both spontaneous and medically indicated preterm birth (aOR 1.51; 95% CI, 1.01-2.24 and aOR 1.85; 95% CI, 1.04-3.27, respectively).
Also, among pregnancies in women with PsA, the investigators noted 25.2% cesarean births vs 18.3% in the non-PsA cohort (aOR 1.52; 95% CI, 1.21-1.91), and a total of 22.7% pregnancies that were induced (14.4% in the non-PsA cohort; aOR 1.64; 95% CI, 1.30-2.07).
No statistically significant differences in pre-eclampsia, gestational diabetes, preterm premature rupture of membranes, or stillbirth risks were noted.
In an analysis of first pregnancies only, researchers observed similar patterns. However, there were increased risks across multiple variables, including preterm birth (10.7% vs 5.7% in PsA vs non-PsA pregnancies; aOR 1.90; 95% CI, 1.33-2.72). In an analysis of subsequent pregnancies only, there was no increased risk for preterm birth but an increased risk for cesarean delivery, specifically emergency cesarean delivery (aOR 1.83; 95% CI, 1.30-2.58 and aOR 2.21; 95% CI, 1.40-3.48, respectively).
Limitations to the study included a lack of data on disease activity and severity, and a small number of births that were classified as preterm, limiting the statistical power.
“The majority of women with PsA have an uneventful pregnancy with respect to adverse outcomes, but we observed increased risks of preterm birth and cesarean deliveries compared [with] non-PsA pregnancies,” the researchers concluded. “Future studies with information on the indication for operative deliveries as well as medically indicated preterm deliveries will further increase knowledge about PsA and pregnancy.”
Remaeus K, Stephansson O, Johansson K, Granath F, Hellgren K. Maternal and infant pregnancy outcomes in women with psoriatic arthritis: a Swedish nationwide cohort study [published online June 12, 2019]. BJOG. doi: 10.1111/1471-0528.15836