Fertility Trends and Adverse Pregnancy Outcomes in Female Patients With Psoriasis in the UK

Importance Evidence regarding fertility trends and obstetric outcomes among patients with psoriasis is limited by studies of small sample sizes, noninclusion of comparators, and the lack of accurate pregnancy records. Objective To investigate fertility rates and obstetric outcomes of pregnancies in female patients with psoriasis compared with age- and general practice-matched comparators without psoriasis. Design, Setting, and Participants This population-based cohort study used data from 887 primary care practices that contributed to the UK Clinical Practice Research Datalink GOLD database between 1998 and 2019, linked to a pregnancy register and Hospital Episode Statistics. There were 6 223 298 patients of common childbearing ages (15-44 years), and 63 681 patients with psoriasis had at least 1 year of follow-up data prior to the diagnosis of psoriasis. For each patient with psoriasis, 5 patients were matched by age from the same general practice. The median follow-up duration was 4.1 years. Data analysis was performed in 2021. Exposures Patients with psoriasis were identified using clinical diagnostic codes from consultations. Main Outcomes and Measures Fertility rates were calculated as the number of pregnancies per 100 patient-years. The outcomes of each pregnancy recorded in the pregnancy register or Hospital Episode Statistics were screened to identify obstetric outcomes. A negative binomial model was used to examine the association between psoriasis and the fertility rate. Logistic regression was applied to compare the association between psoriasis and obstetric outcomes. Results A total of 63 681 patients with psoriasis and 318 405 matched comparators were included in the analysis (median [IQR] age, 30 [22-37] years). Lower fertility rates (rate ratio, 0.75; 95% CI, 0.69-0.83) were found in patients with moderate to severe psoriasis. Compared with matched comparators without psoriasis, pregnancies in patients with psoriasis had a higher risk of loss (odds ratio, 1.06; 95% CI, 1.03-1.10); however, there was no increase in the risks of antenatal hemorrhage, preeclampsia, or gestational diabetes. Conclusion and Relevance In this cohort study, patients with moderate to severe psoriasis had a lower fertility rate, and the risk of pregnancy loss was higher than in matched comparators without psoriasis. Future research should identify the mechanism of increased risk of pregnancy loss among patients with psoriasis.

[1]  C. Morgan,et al.  Mapping opportunities for the earlier diagnosis of psoriasis in primary care settings in the UK: results from two matched case–control studies , 2022, The British journal of general practice : the journal of the Royal College of General Practitioners.

[2]  L. Skov,et al.  Psoriasis and adverse pregnancy outcomes: A nationwide case-control study in 491,274 women in Denmark , 2022, JAAD international.

[3]  O. Christiansen,et al.  Miscarriage matters: the epidemiological, physical, psychological, and economic costs of early pregnancy loss , 2021, The Lancet.

[4]  Zhuoli Zhang,et al.  Maternal and Neonatal Outcomes in Pregnant Women with Psoriasis and Psoriatic Arthritis: A Systematic Review and Meta-Analysis. , 2021, Rheumatology.

[5]  A. Kimball,et al.  Pregnancy Outcomes in Women With Moderate-to-Severe Psoriasis From the Psoriasis Longitudinal Assessment and Registry (PSOLAR) , 2021, JAMA dermatology.

[6]  I. Iskandar,et al.  Systematic review examining changes over time and variation in the incidence and prevalence of psoriasis by age and gender * , 2020, The British journal of dermatology.

[7]  J. Craig,et al.  Patients’ Perspectives and Experience of Psoriasis and Psoriatic Arthritis: A Systematic Review and Thematic Synthesis of Qualitative Studies , 2020, Arthritis care & research.

[8]  R. Payne,et al.  Development and validation of the Cambridge Multimorbidity Score , 2020, Canadian Medical Association Journal.

[9]  L. Smeeth,et al.  Methods to generate and validate a Pregnancy Register in the UK Clinical Practice Research Datalink primary care database , 2019, Pharmacoepidemiology and drug safety.

[10]  T. Bourne,et al.  The psychological impact of early pregnancy loss , 2018, Human reproduction update.

[11]  F. Granath,et al.  Effect of Maternal Psoriasis on Pregnancy and Birth Outcomes: A Population-based Cohort Study from Denmark and Sweden. , 2018, Acta dermato-venereologica.

[12]  M. Andrews,et al.  Psoriasis in those planning a family, pregnant or breast‐feeding. The Australasian Psoriasis Collaboration , 2018, The Australasian journal of dermatology.

[13]  C. Griffiths,et al.  Alcohol-Related Mortality in Patients With Psoriasis: A Population-Based Cohort Study , 2017, JAMA dermatology.

[14]  D. Reeves,et al.  Longitudinal multiple imputation approaches for body mass index or other variables with very low individual-level variability: the mibmi command in Stata , 2017, BMC Research Notes.

[15]  D. Reeves,et al.  Incidence, prevalence and mortality of patients with psoriasis: a U.K. population‐based cohort study , 2016, The British journal of dermatology.

[16]  Julian N. Robinson,et al.  Prospective risk of stillbirth and neonatal complications in twin pregnancies: systematic review and meta-analysis , 2016, British Medical Journal.

[17]  W. Gulliver,et al.  Psoriasis and adverse pregnancy outcomes: a systematic review of observational studies , 2016, The British journal of dermatology.

[18]  Mark Lunt,et al.  Psoriasis and the Risk of Major Cardiovascular Events: Cohort Study Using the Clinical Practice Research Datalink. , 2015, The Journal of investigative dermatology.

[19]  K. Bhaskaran,et al.  Data Resource Profile: Clinical Practice Research Datalink (CPRD) , 2015, International journal of epidemiology.

[20]  G. Vena,et al.  Psoriasis in pregnancy: challenges and solutions , 2015, Psoriasis.

[21]  A. Molina-Leyva,et al.  Sexual dysfunction in psoriasis: a systematic review , 2015, Journal of the European Academy of Dermatology and Venereology : JEADV.

[22]  S. Hernández-Díaz,et al.  Beginning and duration of pregnancy in automated health care databases: review of estimation methods and validation results , 2015, Pharmacoepidemiology and drug safety.

[23]  Murali K. Kolikonda,et al.  Depression and Anxiety Following Early Pregnancy Loss: Recommendations for Primary Care Providers. , 2015, The primary care companion for CNS disorders.

[24]  K. Bhaskaran,et al.  Completeness and usability of ethnicity data in UK-based primary care and hospital databases , 2013, Journal of public health.

[25]  G. Jemec,et al.  Meta-analysis of psoriasis, cardiovascular disease, and associated risk factors. , 2013, Journal of the American Academy of Dermatology.

[26]  A. Armstrong,et al.  Psoriasis and metabolic syndrome: a systematic review and meta-analysis of observational studies. , 2013, Journal of the American Academy of Dermatology.

[27]  Tzeng-Ji Chen,et al.  Psoriasis and increased risk of ischemic stroke in Taiwan: A nationwide study , 2012, The Journal of dermatology.

[28]  T. V. van Staa,et al.  Recent advances in the utility and use of the General Practice Research Database as an example of a UK Primary Care Data resource , 2012, Therapeutic advances in drug safety.

[29]  Z. Nachum,et al.  Pregnancy outcomes in women with moderate‐to‐severe psoriasis , 2011, Journal of the European Academy of Dermatology and Venereology : JEADV.

[30]  Herng‐Ching Lin,et al.  Increased risk of acute myocardial infarction in patients with psoriasis: a 5-year population-based study in Taiwan. , 2011, Journal of the American Academy of Dermatology.

[31]  M. Aral,et al.  Association of Maternal Serum CRP, IL-6, TNF-α, Homocysteine, Folic Acid and Vitamin B12 Levels with the Severity of Preeclampsia and Fetal Birth Weight , 2009, Hypertension in pregnancy.

[32]  J. Seeger,et al.  Pregnancy and Pregnancy Outcome among Women with Inflammatory Skin Diseases , 2006, Dermatology.

[33]  Daniel B. Shin,et al.  Risk of myocardial infarction in patients with psoriasis. , 2006, JAMA.

[34]  S. Greenland,et al.  Proper interpretation of non-differential misclassification effects: expectations vs observations. , 2005, International journal of epidemiology.

[35]  A. Silman,et al.  Women with inflammatory polyarthritis have babies of lower birth weight. , 2001, The Journal of rheumatology.

[36]  M. Fried,et al.  Malaria Elicits Type 1 Cytokines in the Human Placenta: IFN-γ and TNF-α Associated with Pregnancy Outcomes , 1998, The Journal of Immunology.

[37]  Mark Lebwohl,et al.  Psoriasis , 1906, The Lancet.

[38]  A. Kimball,et al.  The impact of psoriasis on pregnancy outcomes. , 2012, The Journal of investigative dermatology.

[39]  Herng‐Ching Lin,et al.  Psoriasis and pregnancy outcomes: a nationwide population-based study. , 2011, Journal of the American Academy of Dermatology.