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Background: Studies on pregnancy complications in women with psoriatic arthritis (PsA) are scarce and have conflicting results concerning the risk for preterm birth, hypertensive disorders and abnormal fetal weight. Disease activity assessment has not been available in most earlier studies.
Objectives: To investigate the possible association of inflammatory active disease and the proportion of preterm birth, preeclampsia/eclampsia/HELLP, gestational hypertension and abnormal fetal weight expressed as small for gestational age (SGA) and large for gestational age (LGA), in women with PsA.
Methods: Data from the Norwegian nationwide observational register RevNatus was linked with data from the Medical Birth Registry of Norway (MBRN). Cases were singleton births in women with psoriatic arthritis (n=121) included in RevNatus 2010 to 2019. Singleton births registered in MBRN during the same decade, excluding births in mothers with rheumatic inflammatory diseases, served as population controls (n = 575 798). Disease activity was assessed by DAS 28 CRP, in 2 nd or 3 rd trimester. Active PsA was defined as DAS 28 CRP ≥2.6 (n= 34) and inactive PsA as DAS 28 CRP < 2.6 (n =75).
Results: Women with inactive PsA were older than the population controls, and women with inactive or active PSA were more often obese and had assisted reproductive technology performed more often than the population controls. The occurrence of nullipara, smoking, diabetes and chronic hypertension was similar in the three groups.
Preeclampsia/eclampsia/HELLP was most frequent in women with active PsA (3/34, 8.8%), with a risk difference of 6.1% (95% CI 0.3 to 20.3) compared to population controls. Gestational hypertension occurred in 2/34 (5.9%) of women with active PsA with a risk difference of 4.2 % (95% CI – 0.0 to 17.4) compared to population controls. In women with inactive PsA the risk of hypertensive disorders was similar to population controls. Preterm birth and abnormal fetal weight did not occur more frequently in women with PsA compared to population controls.
Conclusion: Active PsA increased the risk for hypertensive disorders of pregnancy. Reassuringly, we found no increased risk for preterm birth or abnormal fetal growth in women with PsA.
REFERENCES: NIL.
Preterm birth and hypertensive pregnancy complications in population controls and women with active or inactive psoriatic arthritis, expressed as proportions and risk differences.
| Total | Preterm birth
| % | Risk difference (95% CI) | p-value | |
|---|---|---|---|---|---|
| Population controls | 575798 | 27955 | 4.9 | ||
| active PsA α | 34 | 1 | 2.9 | -2.0 (-4.4 to 10.0) | 0.84 γ |
| inactive PsA α | 75 | 6 | 8.0 | 3.1 (-1.2 to 11.5) | 0.14 γ |
| Total | Preeclampsia
| % | Risk difference (95% CI) | p-value | |
| Population controls | 575798 | 15162 | 2.6 | ||
| active PsA α | 34 | 3 | 8.8 | 6.1 (0.3 to 20.3) | 0.036 γ |
| inactive PsA α | 75 | 1 | 1.3 | -1.4 (-2.5 to 4.5) | 0.59 γ |
| Total | Gestational HT | % | Risk difference (95% CI) | p-value | |
| Population controls | 575798 | 9644 | 1.7 | ||
| active PsA α | 34 | 2 | 5.9 | 4.2 (-0.0 to 17.4) | 0.065 γ |
| inactive PsA α | 75 | 2 | 2.7 | 1.0 (-0.9 to 7.5) | 0.24 γ |
PsA = psoriatic arthritis, HELLP= Hemolysis, Elevated Liver enzymes and Low Platelets, α in 2nd or 3rd trimester, γ The Fishers mid-P test
Acknowledgements: NIL.
Disclosure of Interests: None declared.