Advertisement

Outcome of pregnancy in women with psoriatic arthritis compared to healthy controls

  • Ari Polachek
  • Inbal Polachek Shlomi
  • Karen Spitzer
  • Daniel Pereira
  • Justine Yang Ye
  • Vinod Chandran
  • Carl A. Laskin
  • Dafna D. Gladman
Original Article
  • 12 Downloads

Abstract

Objectives

The mean age at onset of psoriatic arthritis (PsA) ranges between the 4th–6th decades of life. However, little is known about fertility and pregnancy outcome in PsA patients. The aim of this study was to examine whether fertility and pregnancy outcome of PsA patients are different from healthy controls and to evaluate PsA and psoriasis disease activity perception during pregnancy and the year postpartum.

Methods

A questionnaire-based study, including demographic, fertility, pregnancy outcome, and disease activity questions, was conducted in PsA patients and healthy controls. The inclusion criterion was diagnosis of PsA before at least 1 pregnancy. Descriptive statistics are provided. T tests and Pearson chi-square tests were used to analyze the differences between continuous and categorical variables, respectively.

Results

The 74 PsA patients and 74 healthy controls were not significantly different in most of the demographic variables. The mean number of pregnancies, children, and infertility diagnosis were not significantly different between the groups. The pregnancy outcomes in the PsA group (n = 151) and in the control group (n = 189) were similar in: live birth (76% vs. 76%, P = 0.3), vaginal delivery (48% vs. 51%, P = 0.6), gestation age (38.5 vs. 38.3, P = 0.3), weight at birth (3.4 kg vs. 3.4 kg, P = 0.5), low rate of maternal and fetal complications, and the duration and rate of breastfeeding. Most (58%) patients reported favorable joint activity during pregnancy and 50% reported worsening during the 1st postpartum year.

Conclusions

PsA patients do not have more infertility or worse pregnancy outcomes compared to healthy controls.

Keywords

Birth Conception Gestation Pregnancy Psoriasis Spondyloarthritis 

Notes

Funding information

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The University of Toronto Psoriatic Arthritis is supported by a grant from the Krembil Foundation. Dr. Polachek was supported by an unrestricted educational grant from Janssen Canada.

Compliance with ethical standards

Disclosures

None.

Supplementary material

10067_2018_4385_MOESM1_ESM.docx (17 kb)
ESM 1 (DOCX 16 kb)

References

  1. 1.
    Helmick CG, Lee-Han H, Hirsch SC, Baird TL, Bartlett CL (2014) Prevalence of psoriasis among adults in the U.S.: 2003–2006 and 2009–2010 National Health and Nutrition Examination Surveys. Am J Prev Med 47:37–45CrossRefPubMedCentralGoogle Scholar
  2. 2.
    Ogdie A, Langan S, Love T, Haynes K, Shin D, Seminara N, Mehta NN, Troxel A, Choi H, Gelfand JM (2013) Prevalence and treatment patterns of psoriatic arthritis in the UK. Rheumatology (Oxford) 52:568–575CrossRefGoogle Scholar
  3. 3.
    Husted JA, Thavaneswaran A, Chandran V, Eder L, Rosen CF, Cook RJ, Gladman DD (2011) Cardiovascular and other comorbidities in patients with psoriatic arthritis: a comparison with patients with psoriasis. Arthritis Care Res 63:1729–1735CrossRefGoogle Scholar
  4. 4.
    Gladman DD, Chandran V (2011) Observational cohort studies: lessons learnt from the University of Toronto Psoriatic Arthritis Program. Rheumatology (Oxford) 50:25–31CrossRefGoogle Scholar
  5. 5.
    Ritchlin CT, Colbert RA, Gladman DD (2017) Psoriatic arthritis. New Engl J Med 376:957–970CrossRefGoogle Scholar
  6. 6.
    Kammer GM, Soter NA, Gibson DJ, Schur PH (1979) Psoriatic arthritis: a clinical, immunologic and HLA study of 100 patients. Semin Arthritis Rheum 9:75–97CrossRefGoogle Scholar
  7. 7.
    Veale D, Rogers S, Fitzgerald O (1994) Classification of clinical subsets in psoriatic arthritis. Br J Rheumatol 33:133–138CrossRefGoogle Scholar
  8. 8.
    Polachek A, Li S, Polachek IS, Chandran V, Gladman D (2017) Psoriatic arthritis disease activity during pregnancy and the first-year postpartum. Semin Arthritis Rheum 46:740–745CrossRefGoogle Scholar
  9. 9.
    Ostensen M (1992) The effect of pregnancy on ankylosing spondylitis, psoriatic arthritis, and juvenile rheumatoid arthritis. Am J Reprod Immunol 28:235–237CrossRefGoogle Scholar
  10. 10.
    Ostensen M (1988) Pregnancy in psoriatic arthritis. Scand J Rheumatol 17:67–70CrossRefGoogle Scholar
  11. 11.
    Gladman DD, Thavaneswaran A, Chandran V, Zummer M (2012) Psoriatic arthritis (PsA) in Canadian Clinical Practice: the PsA Assessment in Rheumatology (PAIR). J Rheumatol 39:1850–1853CrossRefGoogle Scholar
  12. 12.
    Østensen M (2017) Sexual and reproductive health in rheumatic disease. Nat Rev Rheumatol 13:485–493CrossRefGoogle Scholar
  13. 13.
    Wallenius M, Skomsvoll JF, Irgens LM, Salvesen KÅ, Nordvåg BY, Koldingsnes W, Mikkelsen K, Kaufmann C, Kvien TK (2011) Fertility in women with chronic inflammatory arthritides. Rheumatology (Oxford) 50:1162–1167CrossRefGoogle Scholar
  14. 14.
    Clowse ME, Chakravarty E, Costenbader KH, Chambers C, Michaud K (2012) Effects of infertility, pregnancy loss, and patient concerns on family size of women with rheumatoid arthritis and systemic lupus erythematosus. Arthritis Care Res (Hoboken) 64:668–674CrossRefGoogle Scholar
  15. 15.
    Ostensen M, Ostensen H (1998) Ankylosing spondylitis-the female aspect. J Rheumatol 25:120–124Google Scholar
  16. 16.
    Wallenius M, Skomsvoll JF, Irgens LM, Salvesen KÅ, Nordvåg BY, Koldingsnes W, Mikkelsen K, Kaufmannm C, Kvien TK (2011) Pregnancy and delivery in women with chronic inflammatory arthritides with a specific focus on first birth. Arthritis Rheum 63:1534–1542CrossRefGoogle Scholar
  17. 17.
    Mouyis MA, Thornton CC, Williams D, Giles IP (2017) Pregnancy outcome in patients with psoriatis arthritis. Rheumatol 44:128–129Google Scholar
  18. 18.
    Bröms G, Haerskjold A, Granath F, Kieler H, Pedersen L, Berglind IA (2018) Effect of maternal psoriasis on pregnancy and birth outcomes: a population-based cohort study from Denmark and Sweden. Acta Derm Venereol 98:728–734CrossRefPubMedCentralGoogle Scholar
  19. 19.
    Götestam SC, Hoeltzenbein M, Tincani A, Fischer-Betz R, Elefant E, Chambers C et al (2016) The EULAR points to consider for use of antirheumatic drugs before pregnancy, and during pregnancy and lactation. Ann Rheum Dis 75:795–810CrossRefGoogle Scholar
  20. 20.
    Murase JE, Chan KK, Garite TJ, Cooper DM, Weinstein GD (2005) Hormonal effect on psoriasis in pregnancy and postpartum. Arch Dermatol 141:601–606CrossRefGoogle Scholar
  21. 21.
    Holland D, Bretscher P, Russell AS (1984) Immunologic and inflammatory responses during pregnancy. J Clin Lab Immunol 14:177–179Google Scholar
  22. 22.
    Nelson JL, Hughes KA, Smith AG, Nisperos BB, Branchaud AM, Hansen JA (1993) Maternal-fetal disparity in HLA class II alloantigens and the pregnancy-induced amelioration of rheumatoid arthritis. N Engl J Med 329:466–471CrossRefGoogle Scholar
  23. 23.
    McHugh NJ, Laurent MR (1989) The effect of pregnancy on the onset of psoriatic arthritis. Br J Rheumatol 28:50–52.23CrossRefGoogle Scholar
  24. 24.
    Thumboo J, Uramoto K, Shbeeb MI, O'Fallon WM, Crowson CS, Gibson LE et al (2002) Risk factors for the development of psoriatic arthritis: a population based nested case control study. Rheumatol 29:757–762Google Scholar
  25. 25.
    Eder L, Law T, Chandran V, Shanmugarajah S, Shen H, Rosen CF, Cook RJ, Gladman DD (2011) Association between environmental factors and onset of psoriatic arthritis in patients with psoriasis. Arthritis Care Res (Hoboken) 63:1091–1097CrossRefGoogle Scholar
  26. 26.
    Pattison E, Harrison BJ, Griffiths CE, Silman AJ, Bruce IN (2008) Environmental risk factors for the development of psoriatic arthritis: results from a case-control study. Ann Rheum Dis 67:672–676CrossRefGoogle Scholar
  27. 27.
    Quigley MA, Hockley C, Davidson LL (2007) Agreement between hospital records and maternal recall of mode of delivery: evidence from 12 391 deliveries in the UK Millennium Cohort Study. BJOG 114:195–200CrossRefGoogle Scholar
  28. 28.
    Amissah EA, Kancherla V, Ko YA, Li R (2017) Validation study of maternal recall on breastfeeding duration 6 years after childbirth. J Hum Lact 33:390–400CrossRefGoogle Scholar
  29. 29.
    Olson JE, Shu XO, Ross JA, Pendergrass T, Robison LL (1997) Medical record validation of maternally reported birth characteristics and pregnancy-related events: a report from the Children’s Cancer Group. Am J Epidemiol 145:58–67CrossRefGoogle Scholar

Copyright information

© International League of Associations for Rheumatology (ILAR) 2018

Authors and Affiliations

  1. 1.Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic DiseasesUniversity of TorontoTorontoCanada
  2. 2.Department of Rheumatology, Tel Aviv Sourasky Medical Center, Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
  3. 3.Reproductive life Stages ProgramWomen’s College HospitalTorontoCanada
  4. 4.Beer Yaakov- Ness Ziona Mental Health Center, Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
  5. 5.TRIO FertilityUniversity of TorontoTorontoCanada
  6. 6.Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic DiseaseToronto Western HospitalTorontoCanada
  7. 7.Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research InstituteUniversity Health NetworkTorontoCanada
  8. 8.Departments of Medicine and Laboratory Medicine and PathobiologyUniversity of TorontoTorontoCanada
  9. 9.Departments of Medicine (Rheumatology) and Obstetrics and Gynecology (REI), TRIO FertilityUniversity of TorontoTorontoCanada
  10. 10.Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic DiseaseToronto Western HospitalTorontoCanada

Personalised recommendations