Autoimmune Skin Conditions Can Increase Likelihood of Maternal and Infant Pregnancy Complications

Patients with autoimmune skin diseases (ASDs) carry increased risks of adverse pregnancy outcomes (APOs), such as spontaneous abortions, compared with those without, according to a recent study published in the American Journal of Obstetrics & Gynecology MFM.

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Higher incidences of APOs, such as stillbirth, preeclampsia and eclampsia, spontaneous abortion, and intrauterine growth restriction (IUGR), have all been linked to systemic autoimmune conditions. As the authors of the present study mention, a large fraction of patients enduring ASDs are women of reproductive age. Despite this, however, insufficient research has been conducted on pregnancy outcomes in this population, and these studies are especially lacking in the United States. To address this gap, researchers conducted a case-control study to investigate the risk factors and rates of APOs in patients with ASDs.

Patients were identified through the TriNetX US Collaboratie Network between January 1, 2016, and December 31, 2022. A total of 2799 pregnant patients with ASDs were then matched with healthy controls and controls with systemic rheumatologic conditions (rheumatoid arthritis [RA] or systemic lupus erythematosus [SLE]). The identified ASDs included bullous pemphigoid, dermatitis herpetiformis, alopecia areata (AA), cutaneous lupus erythematosus (CLE), morphea, pemphigus foliaceus, epidermolysis bullosa acquisita, pemphigus vulgaris, amyopathic diabetes mellitus, cicatricial pemphigoid, and vitiligo. Fetal or maternal complications occurring within 2 weeks of the pregnancy end point were the primary outcomes of interest.

Compared with control individuals, pregnant patients with ASDs carried higher risks for spontaneous abortions (OR, 1.54; P < .001). Additionally, compared with those with SLE, patients with ASDs also had higher chances of having gestational hypertension (OR, 1.34; P = .04) and gestational diabetes (OR, 1.8; P = .002); however, patients with SLE were more likely to experience preterm birth (P = .04), stillbirth (P = .04), and intrauterine growth restriction (P = .01). The authors note these 3 APOs are often linked to preeclampsia; patients with ASDs did not experience increased rates of preeclampsia (OR, 1.1; P = .31) and this could explain their reduced rates of APOs in this regard. Rates of APOs were similar between patients with ASDs and those with RA.

The clinical implications of these findings demonstrate that patients with ASDs have higher risk of spontaneous abortions in particular. The authors point to the administration of disease-modifying antirheumatic drugs in treatments of ASDs as a potential explanation. They go on to note how autoantibodies and disease flare-ups have been linked to APOs in patients with RA and SLE, and the use of medications such as leflunomide, mycophenolate mofetil, or methotrexate could be connected to APOs experienced by those with ASDs.

The authors iterate how, to their knowledge, this is the first study evaluating APO rates for patients with ASDs at the population level. Contextualizing their results by comparing patients with ASDs with those with SLE and RA, in their view, can enable expanding research in this area and understanding the risks at hand—especially because the previous research has been impacted by smaller cohorts’ limited cases due to the rarity of ASDs. As they conclude, the authors emphasize that, given their results, patients with ASDs could benefits from closer monitoring and multidisciplinary specialists and forms of care.

Reference

Keum H, Bermas B, Patel S, Jacobe HT, Chong BF. Patients with autoimmune skin diseases are at increased risk of adverse pregnancy outcomes. Am J Obstet Gynecol MFM. Published online November 14, 2023. doi:10.1016/j.ajogmf.2023.101226