Risk of Preterm Birth, Cesarean Higher in PsA Pregnancies

Pregnant women with psoriatic arthritis (PsA) — particularly those who required antirheumatic treatment during pregnancy—were at increased risk of preterm birth and cesarean delivery, according to results from a nationwide cohort study published in Arthritis & Rheumatology.

“The risk estimates varied according to the presence, timing, and type of antirheumatic treatment, which was used as a proxy for disease severity and activity,” researchers reported. “The results may indicate that a more severe or active PsA disease that requires antirheumatic treatment during pregnancy, especially bDMARDs [biologic disease-modifying antirheumatic drugs], is associated with increased risks of adverse pregnancy outcomes compared to non-PsA pregnancies.”

The study included 921 PsA pregnancies matched 1:10 for maternal age, year of delivery, and parity with 9210 non-PsA pregnancies in Sweden. Rates of obesity, smoking, and pregestational hypertension and diabetes mellitus were higher among pregnant women with PsA compared with pregnant women without PsA.

Compared with non-PsA pregnancies, PsA pregnancies were at increased risk of preterm birth and cesarean delivery, the study found. Adjusted odds ratios were 1.69 for preterm birth, 1.77 for elective cesarean delivery, and 1.42 for emergency cesarean delivery.

Antirheumatic treatment during PsA pregnancy had an adjusted odds ratio of 2.30 for preterm birth compared with non-PSA pregnancy, while biologic antirheumatic treatment during PsA pregnancy had an adjusted odds ratio of 4.49 for preterm birth. The increased risk of preterm birth was primarily in first pregnancies, according to the study.

“Our interpretation is that PsA that requires continued antirheumatic treatment during pregnancy is more severe than PsA that does not require treatment. Thus, the increased risk of adverse outcomes in pregnancies with maternal  antirheumatic treatment is probably attributed to disease severity rather than an effect of the medication itself,” researchers wrote.

They advised the need for counseling about pregnancy outcomes for all women with PsA as well as individualized monitoring during pregnancy, regardless of antirheumatic treatment status.

—Jolynn Tumolo

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.