Treatment of Psoriatic Arthritis in Pregnant Women Increases Risks

Pregnant women who are treated for psoriatic arthritis (PsA) are at a higher risk for preterm birth and cesarean delivery compared with women who are pregnant without PsA, according to a study that evaluated antirheumatic treatment in pregnant women.

“[PsA] is a chronic inflammatory arthritis disease that affects women of childbearing age and has a heterogeneous clinical presentation, with related extraarticular manifestations,” the authors wrote. “Studies describing maternal and neonatal pregnancy outcomes in women with PsA are few, but some indicate an increased risk of preterm birth and cesarean delivery.”

The researchers conducted a registry-based cohort study, which included 921 pregnant women with PsA and 9210 pregnant women without PsA that occurred between 2007 and 2017. Primarily, the researchers observed an increased risk in preterm birth in PsA pregnancies when compared with non-PsA pregnancies (adjusted odds ratio [OR] = 1.69 [95% CI; 1.27 - 2.24]) and cesarean delivery (adjusted OR = 1.77 [95% CI; 1.43 - 2.20] for elective delivery and adjusted OR = 1.42 [95% CI; 1.10 - 1.84] for emergency delivery).

Further, the researchers noted, the risks differed according to the presence, timing, and type of antirheumatic treatment a patient received. The researchers found that risk of preterm birth increased in first pregnancies.

“In comparison to non-PsA pregnancies, the risks of adverse outcomes were most increased in pregnancies exposed to antirheumatic treatment, especially bDMARDs, during pregnancy," the researchers concluded. “As parity influences the risk of preterm birth, special attention to first PsA pregnancies is warranted to ensure optimal treatment strategies,” the researchers concluded. From a clinical point of view, all women with PsA, regardless of antirheumatic treatment, should be counseled about pregnancy outcomes and receive individualized monitoring during pregnancy.”

The researchers made note of an important limitation, acknowledging that they did not have information on disease activity measurements such as the Disease Activity Score in 28 joints using C-reactive protein level.

Reference:

Remaeus K, Johansson K, Granath F, Stephansson O, Hellgren K. Pregnancy outcomes in women with psoriatic arthritis in relation to presence and timing of antirheumatic treatment. Arthritis Rheumatol. 2022;74(3):486-495. doi:10.1002/art.41985