• Women with psoriatic arthritis (PsA) face higher risks during pregnancy, including greater chances of giving birth prematurely or needing a cesarean section (C-section), according to a new study.
• Risks were highest for women with more severe disease who needed to use treatments like biologics.
• Researchers recommended that pregnant individuals with PsA receive counseling and individualized monitoring.

Women with psoriatic arthritis are nearly 70 percent more likely to give birth prematurely and 42 percent more likely to require a C-section, compared to those without PsA, a new study found. Pregnancy-associated risks were higher among those being treated for more severe PsA. The research was published Oct. 20 in the journal Arthritis & Rheumatology.

Psoriatic arthritis is a chronic inflammatory disease that causes joint pain, swelling, and stiffness. Up to 30 percent of people with psoriasis may develop PsA as well.

In the Sweden-based study, researchers collected data — spanning 2007 through 2017 — from 921 pregnant women with psoriatic arthritis. Their information was compared with data from 9,210 women without the condition.

The study authors found that women with PsA were:

• 69 percent more likely to have a premature birth
• 77 percent more likely to choose to have a C-section
• 42 percent more likely to need an emergency C-section

However, PsA did not increase a woman’s risk of other potential pregnancy problems, including preeclampsia, hypertension (high blood pressure), gestational diabetes, or abnormal birth weight of the baby.

Researchers also looked at whether PsA treatments could affect pregnancy outcomes. About half of the women with PsA received treatments during pregnancy, or within one year of becoming pregnant. The treatments included corticosteroids, conventional disease-modifying antirheumatic drugs (DMARDs), and biologics.

Women who were using PsA treatments were more likely to give birth prematurely or to undergo a C-section. In particular, using biologics led to the highest risk. Women using biologic medications were:

• 4.5 times more likely to have a preterm birth
• 2.7 times more likely to choose a C-section
• 2 times more likely to need an emergency C-section
• 2.88 times more likely to develop preeclampsia

The study authors didn’t think that the PsA treatments themselves led to problems during pregnancy. Rather, they hypothesized that women who needed treatments were more likely to have severe PsA, and severe disease is what leads to a higher risk of pregnancy complications.

The authors concluded, “All women with PsA, regardless of antirheumatic treatment, should be counselled about pregnancy outcomes and receive individualized monitoring during pregnancy.”