Pregnancy Risks Higher Among Patients With PsA on Biologics

A cohort study that included 921 pregnancies among patients with psoriatic arthritis (PsA) and 9,210 pregnancies among patients without PsA indicated that patients with PsA who were treated with biologic therapies during pregnancy had significantly increased risks of preterm birth.

The study drew from a Swedish nationwide registry of patients whose pregnancies occurred between 2007 and 2017. Researchers evaluated the outcomes of pregnancy among patients with PsA who were treated with antirheumatic therapies, as proxy for disease severity.

Patients were matched 1:10 according to maternal age, year of delivery, and parity. The investigators estimated adjusted odds ratios overall, with 95% confidence intervals (95% CIs). They stratified patients according to the use, timing, and type of antirheumatic treatment and also adjusted for maternal body mass index, smoking, education level, and country of birth.

“Pregnant women with PsA versus those without PsA were more obese, more often smokers, and more frequently had a diagnosis of pregestational hypertension and diabetes mellitus,” the authors wrote. “Increased risks in PsA pregnancies versus non-PsA pregnancies were primarily preterm birth (adjusted 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).”

The presence, timing, and type of antirheumatic treatment affected these risks, the researchers explained, “with the most increased risk in PsA pregnancies (versus non-PsA) occurring with antirheumatic treatment during pregnancy (adjusted OR 2.30 [95% CI 1.49–3.56] for preterm birth). The corresponding adjusted OR for preterm birth in women with PsA who were exposed specifically to biologic treatment during pregnancy was 4.49 [95% CI 2.60–7.79]. Risk of preterm birth was primarily increased in first pregnancies.”

Compared to pregnancies among patients without PsA, those patients with PsA had higher risks of preterm birth and cesarean delivery, and were increased most among those exposed to antirheumatic treatment during pregnancy, especially biologic treatments.

“As parity influences the risk of preterm birth in women with PsA, special attention to first pregnancies is warranted. Women with PsA should receive individualized monitoring during pregnancy,” the authors wrote.

—Rebecca Mashaw

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   https://doi.org/10.1002/art.41985