Psoriasis and adverse pregnancy outcomes: A nationwide case-control study in 491,274 women in Denmark

Cæcilie Bachdal Johansen; Alexander Egeberg; Espen Jimenez-Solem; Lone Skov; Simon Francis Thomsen

doi:10.1016/j.jdin.2022.03.009

Psoriasis and adverse pregnancy outcomes: A nationwide case-control study in 491,274 women in Denmark

JAAD Int. 2022 Apr 19:7:146-155. doi: 10.1016/j.jdin.2022.03.009. eCollection 2022 Jun.

Authors

Cæcilie Bachdal Johansen^{1

2}, Alexander Egeberg^{1

3}, Espen Jimenez-Solem^{2

4

5}, Lone Skov^{3

4}, Simon Francis Thomsen^{1

6}

Affiliations

¹ Department of Dermatology and Venereology, Bispebjerg And Frederiksberg Hospital, Copenhagen, Denmark.
² Department of Clinical Pharmacology, Bispebjerg And Frederiksberg Hospital, Copenhagen, Denmark.
³ Department of Dermatology and Allergy, Herlev and Gentofte Hospital, Copenhagen, Denmark.
⁴ Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
⁵ Copenhagen Phase IV Unit (Phase4CPH), Department of Clinical Pharmacology and Center for Clinical Research and Prevention, Bispebjerg And Frederiksberg Hospital, Copenhagen, Denmark.
⁶ Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark.

Abstract

Background: The chronic systemic inflammation associated with psoriasis supposedly creates an undesirable milieu for a pregnancy, resulting in an increased risk of adverse pregnancy outcomes (APOs).

Objective: To investigate the association between psoriasis and APOs as well as how the association differs according to psoriasis severity (mild and moderate-to-severe).

Methods: This nationwide register-based case-control study collected data from 1973 to 2017. Cases were APOs (spontaneous abortion, ectopic pregnancy [EP], intrauterine fetal death, and stillbirth). Singleton live births were controls. Adjusted logistic regression models were used for statistical analyses.

Results: In total, 42,041 (8.56%) APOs and 449,233 (91.44%) controls were included. EP was the only APO that was found to be statistically associated with psoriasis (odds ratio, 1.34; 95% CI, 1.06-1.68). Odds ratio for EP was the highest for women with moderate-to-severe psoriasis (odds ratio, 2.77; 95% CI, 1.13-6.76). 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: No access to clinical data confirming psoriasis severity.

Conclusion: The present study found a significant association between EP and psoriasis (absolute risk of 3.98%). As EP is the leading cause of maternal morbidity and mortality in the first trimester of pregnancy, our findings call for particular care for women of reproductive age with psoriasis.

Keywords: APO, adverse pregnancy outcome; EP, ectopic pregnancy; IBD, inflammatory bowel disease; ICD-10, International Statistical Classification of Diseases, Tenth Revision; IUFD, intrauterine fetal death; OR, odds ratio; PsA, psoriatic arthritis; Th17, T helper cell type 17; ectopic pregnancy; fetal death; pregnancy; pregnancy outcome; psoriasis; psoriasis severity; spontaneous abortion; stillbirth; women.