Psoriasis May Increase Risk of Ectopic Pregnancy, a Driver of Maternal Morbidity

Risk of ectopic pregnancy (EP), the leading cause of maternal morbidity and mortality in the first trimester of pregnancy, was significantly associated with psoriasis, especially in women with moderate to severe disease. Study findings were published in JAAD International.

As a chronic immune-mediated inflammatory disease, the systemic inflammation involved in psoriasis has been indicated to be driven by T helper type 17 (Th17) cells. Researchers highlight that an excess of Th17 cells is known to be associated with adverse pregnancy outcomes (APOs) related to fecundity and fertility.

“Chronic immune-mediated diseases with shared pathophysiologic pathways with psoriasis such as psoriatic arthritis, rheumatoid arthritis, and inflammatory bowel disease have been associated with APOs,” the study authors wrote.

“To date, studies regarding psoriasis and APOs have been limited because of either a small sample size or using composite outcomes, mixing pregnancy outcomes with maternal and neonatal outcomes. Thus, large nationwide studies are needed with a focus on APOs in women with psoriatic disease,” they added.

They conducted a nationwide register-based case-control study of data derived from the Danish National Patient Registry and Danish Medical Birth Register between 1973 and 2017. Participants were evaluated for the primary outcomes of spontaneous abortion, EP, intrauterine fetal death (IUFD), and stillbirth, identified using International Classification of Diseases, Tenth Revision codes.

“Singleton live births were controls. Adjusted logistic regression models were used for statistical analyses,” the authors noted.

A total of 491,274 women were included in the study, of whom 449,233 (91.44%) were controls and 42,041 (8.56%) had APOs: 32,750 (6.67%) spontaneous abortions, 7387 (1.50%) EPs, 1228 (0.25%) IUFDs, and 676 (0.14%) stillbirths. Incidence of psoriasis was reported in 6426 (1.31%) female participants, with 6225 (96.87%) and 201 (3.13%) identified as having mild and moderate to severe disease, respectively.

After adjusting for potential confounders, EP was shown to be statistically associated with psoriasis (odds ratio [OR], 1.34; 95% CI, 1.06-1.68), whereas the other APOs were not significantly linked with the disease.

The highest risk for EP was reported in women with moderate to severe psoriasis, who were 2.7 times more likely to experience this APO (OR, 2.77; 95% CI, 1.13-6.76). Moreover, the absolute risk of EP was 2.48% higher for women with moderate to severe psoriasis compared with women without psoriasis (3.98% vs 1.50%).

Limitations of the analysis included the lack of access to clinical data confirming psoriasis severity.

“Our findings call for particular care for women of reproductive age with psoriasis, that is, informing sexually active patients to seek emergency gynecologic evaluation in case of lower abdominal pain, unplanned absence of menstruation, and concurrent light vaginal bleeding,” the authors concluded. “Clinical studies are needed to examine the potential causality between psoriasis and APOs.”

Reference

Johansen CB, Egeberg A, Jimenez-Solem E, Skov L, Thomsen SF. Psoriasis and adverse pregnancy outcomes: a nationwide case-control study in 491,274 women in Denmark. JAAD Int. 2022;7:146-155. doi:10.1016/j.jdin.2022.03.009