Individualized monitoring needed for pregnant women being treated for PsA

Pregnant women with psoriatic arthritis (PsA) who are receiving treatment with antirheumatic drugs, especially biologics, are at risk of delivering preterm and via caesarean section, according to a study, highlighting the importance of individualized monitoring during pregnancy in this population.

The study used data from a Swedish nationwide registry–based cohort study that included 921 PsA pregnancies and 9,210 non-PsA pregnancies (control) matched based on maternal age, year of delivery, and parity.

Pregnant women with vs without PsA were more likely to be obese, a smoker at the first antenatal visit, and have prepregnancy hypertension or type 1 or type 2 diabetes.

Among women in the PsA group who received antirheumatic treatment only before pregnancy (n=170), 39.4 percent received a conventional synthetic disease-modifying antirheumatic drug (csDMARD; eg, antimalarials, methotrexate, sulfasalazine), whereas 24.1 percent were treated with oral glucocorticoids and 15.9 percent with tumour necrosis factor inhibitors (TNFis). Around 20 percent of women received ≥2 types of antirheumatic drugs before pregnancy.

Compared with the control group, the PsA group had much higher risks of preterm birth (adjusted odds ratio [aOR], 1.69, 95 percent confidence interval [CI], 1.27–2.24) and caesarean delivery (elective delivery: aOR, 1.77, 95 percent CI, 1.43–2.20; emergency delivery: aOR, 1.42, 95 percent CI, 1.10–1.84).

Of note, the risks varied according to the presence, timing, and type of antirheumatic treatment. For example, the highest risk of preterm birth was noted among women with PsA who were exposed to biologic (aOR, 4.49, 95 percent CI, 2.60–7.79) or antirheumatic treatment (aOR, 2.30, 95 percent CI, 1.49–3.56) during pregnancy. This risk was primarily elevated in first pregnancies.