Psoriasis and Pregnancy Outcomes: Q&A With Dr Alexa Kimball

Alexa Kimball, MD, MPH, is president and chief executive officer of Harvard Medical Faculty Physicians at BIDMC Inc. in Boston, MA. She is also president of the Beth Israel Deaconess Care Organization (BIDCO) Physician LLC, and a professor of dermatology at Harvard Medical School. Dr Kimball’s areas of expertise include psoriasis, hidradenitis suppurativa, and the physician workforce, and she has published more than 300 papers and authored books regarding these topics and other dermatologic topics. Dr Kimball joined The Dermatologist to discuss her latest study, “Pregnancy Outcomes in Women With Moderate-to-Severe Psoriasis From the Psoriasis Longitudinal Assessment and Registry (PSOLAR).”¹

What were the reasons you and your team conducted this study?
Given the chronic nature of psoriasis, women often have questions about how their disease and/or treatments might affect their fertility or the outcomes of their pregnancies. As we were studying a very large cohort of patients for up to 8 years, it was a superb opportunity to help answer these questions.

Your study found that “overall and live birth outcomes were similar to those for the general population.” What is the significance of these findings?
The women in our study typically had moderate to severe disease and often were on systemic therapy during the course of the registry. This study confirms that neither their disease nor their treatments were generally resulting in problematic outcomes. Of course, there are still individuals with risk factors, and some treatments should be avoided. Nonetheless, there were clearly many successful and uneventful pregnancies, which should be reassuring to women considering getting pregnant.

Can you share what areas of future research are needed to better understand the relationship between pregnancy outcomes and moderate to severe psoriasis?
We still don’t understand why women with psoriasis appear to have lower birth rates than the comparable United States population and more robust data with larger numbers of women who take, eg, biologics during pregnancy, would be great additions to our knowledge.

According to the study, “pregnancy outcomes for women exposed to biologics were similar to those for women exposed to nonbiologics.” While the outcomes were similar, were there any impacts on patients with moderate to severe psoriasis who were pregnant’s quality of life (QPL)?
We didn’t evaluate QPL in the women who were pregnant and continued treatment compared to those who did not, but clearly keeping expectant moms comfortable is a priority. There is also data from other immunologic diseases suggesting that outcomes may be worse in patients whose underlying disease is out for control. In general, we suggest a frank conversation about the choices available and shared decision making to establish the goals of treatment.

Is there anything else you would like to share regarding pregnancy outcomes or psoriasis?
The great news is that there are many, really effective treatments for psoriasis. While there are important differences across them in terms of safety, most women who need treatment during pregnancy can find a regimen that will keep their disease in check and not lead to any harmful consequences.

Reference
Kimball AB, Guenther L, Kalia S, et al. Pregnancy outcomes in women with moderate-to-severe psoriasis from the psoriasis longitudinal assessment and registry (PSOLAR). JAMA Dermatol. 2021;157(3):301-306. doi:10.1001/jamadermatol.2020.5595