Pregnancy Outcomes in Women With Moderate-to-Severe Psoriasis From the Psoriasis Longitudinal Assessment and Registry (PSOLAR)

Key Points

Question

Is there an association between pregnancy outcomes and psoriasis or exposure to systemic therapies for moderate-to-severe psoriasis?

Findings

This cohort study used data from the Psoriasis Longitudinal Assessment and Registry (PSOLAR) for 220 women with 298 pregnancies, of which 244 (81.9%) resulted in live births. Rates of spontaneous abortion, neonatal problems, and congenital anomalies were similar to rates in the general US population, and pregnancy outcomes for women exposed to biologics were similar to those for women with exposure to nonbiologics.

Meaning

Pregnancy outcomes among women with moderate-to-severe psoriasis within PSOLAR appeared to be consistent with previously reported data; pregnancy-specific registries are needed to more fully characterize the effect of psoriasis and its treatment on birth outcomes.

Abstract

This cohort study reports pregnancy outcomes observed among women enrolled in the Psoriasis Longitudinal Assessment and Registry.

Abstract

Importance

Prospective data are limited on pregnancy outcomes among women with psoriasis who may be receiving biologic or conventional systemic therapy.

Objective

To report pregnancy outcomes observed in the Psoriasis Longitudinal Assessment and Registry (PSOLAR).

Design, Setting, and Participants

This cohort study used data from PSOLAR, a multicenter, disease-based, observational registry evaluating long-term safety and clinical outcomes for patients receiving or eligible to receive treatment for psoriasis with biologics and/or conventional systemic therapies. Of 12 090 enrollees, 5456 were women (45.1%), and 2224 women were of childbearing age (18-45 years). Participants had a total of 12 929 patient-years of follow-up (median, 7.2 [range, 3.3-8.0] years per patient). Data were collected from June 20, 2007, to August 23, 2019, and analyzed from April 23 to June 23, 2020.

Exposures

Exposure to biologics within the prenatal period (≤1 year before birth or ≤6 months before spontaneous abortion) or at any other time.

Main Outcomes and Measures

Descriptive summaries of pregnancies and pregnancy-related outcomes were self-reported in PSOLAR, including births, stillbirths, spontaneous abortions, and elective terminations. Live birth characteristics collected in PSOLAR include whether a birth was full-term (≥37 weeks) or premature (<37 weeks) and whether neonatal adverse events or congenital anomalies occurred.

Results

A total of 298 pregnancies occurred among 220 women (mean [SD] age, 27.8 [5.2] years), and the general fertility rate was 18.9 per 1000 women aged 18 to 45 years. Of the 298 pregnancies, 244 (81.9%) resulted in birth, 41 (13.8%) ended in spontaneous abortion, and 13 (4.4%) were electively terminated. Gestational age was available for 243 births; 221 infants (90.9%) were full-term, and 22 (9.1%) were born prematurely. Birth outcomes included 231 healthy newborns, 10 infants with a neonatal problem, 2 infants with a congenital anomaly, and 1 stillbirth. Of the 298 pregnancies, 252 were associated with biologic exposure before or during pregnancy. Pregnancy outcomes for women exposed to biologics were similar to those for women exposed to nonbiologics. Among women who became pregnant, mean (SD) age at the time of pregnancy outcome was 30.9 (4.8) years; at enrollment into the registry, 74 of 219 (33.8%) had obesity, and 121 of 220 (55.0%) were past or current smokers.

Conclusions and Relevance

The findings of this cohort study suggest that pregnancy outcomes in PSOLAR have remained consistent with previous reports. Overall and live birth outcomes were similar to those for the general population.