Increased Preterm Birth Risk in Psoriatic Arthritis Pregnancies Save

Pregnancy outcomes may be affected by psoriatic arthritis or antirheumatic treatment; registry cohort study shows that preterm birth and cesarean delivery were mostly increased by antirheumatic treatment, especially biologics.

A nationwide Swedish register studied 921 PsA-pregnancies and compared outcomes to a matched (1:10) cohort of and 9210 non-PSA-pregnancies. Adjusted odds ratios (aOR) were calculated for the effect of antirheumatic treatments, after adjustments for BMI, smoking, educational level, country of birth and parity.

Compared to non-PsA-pregnancies, PsA pregnant women were more likely to be obese, smokers and a greater frequency of pre-gestational hypertension and diabetes. Moreover, PsA -pregnancies had a higher risk of:

• Preterm birth: aOR 1.69, 95% CI 1.27-2.24
• Elective cesarean delivery: aOR 1.77, 95% CI 1.43-2.20
• Emergent cesarean delivery: aOR 1.42, 95% CI 1.10-1.84

An increased risk of preterm birth was seen with:

• Antirheumatic treatment (during PsA-pregnancies) (aOR 2.30, 95% CI 1.49-3.56)
• Biologic exposure (aOR 4.49, 95% CI 2.60-7.79)
• First pregnancies (aOR 3.95, 95% CI 1.43-10.95)

This analysis is limited as disease activity measures were not available; hence these associations point biologics and antirheumatic therapy, when disease activity could well be a pivotal factor in preterm births (as has been shown in other diseases).