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TOPLINE:

In a large retrospective cohort study, exposure to biologics during pregnancy was not associated with increased adverse pregnancy outcomes (APOs) in women with psoriasis compared with biologic-naive pregnant women with psoriasis.

METHODOLOGY:

• Researchers conducted a retrospective cohort study using electronic medical record data from 1226 biologic-exposed pregnant women with psoriasis (mean age, 31.8 years) and 1238 biologic-naive pregnant women with psoriasis (control group; mean age, 33.1 years) between 2010 and 2024 at a tertiary medical center in Israel.
• Biologic agents included tumor necrosis factor alpha (TNF alpha) inhibitors (adalimumab, etanercept, infliximab, certolizumab), interleukin (IL)-17 inhibitors (secukinumab, ixekizumab), IL-23 inhibitors (guselkumab, risankizumab, tildrakizumab), and the IL-12/23 inhibitor ustekinumab.
• Among biologic-exposed pregnancies, all women (100%) received at least one biologic dose during the preconception period, 163 pregnancies (13.3%) had exposure after pregnancy confirmation, and 144 pregnancies (11.7%) had confirmed continued exposure into the third trimester.
• The primary outcomes were APOs, including spontaneous abortion, stillbirth or intrauterine fetal death, preterm birth (before 37 weeks’ gestation), small for gestational age, low birth weight (less than 2500 g), gestational hypertension, gestational diabetes mellitus, and placental complications.

TAKEAWAY:

• Biologic-exposed pregnancies were less likely to experience any APO than unexposed ones (24.14% vs 29.97%; odds ratio [OR], 0.76; P = .00128).
• Spontaneous abortion rates were lower among those on a biologic (8.40% vs 10.90%; OR, 0.75; P = .0406), as was gestational diabetes mellitus (4.16% vs 7.43%; OR, 0.54; P = .00054).
• Other APOs, including stillbirth (1.55% vs 1.53%; OR, 1.01), preterm birth (0.82% vs 0.57%; OR, 1.45), preeclampsia (0.90% vs 0.81%; OR, 1.11), and gestational hypertension (0.98% vs 1.29%; OR, 0.75; P > .05 for all) occurred at comparable frequencies in both groups.
• Among biologic-exposed pregnancies, the overall frequency of any APO was similar across biologic classes (TNF alpha inhibitors, 24.7%; IL-17 inhibitors, 18.9%; IL-12/23 or IL-23 inhibitors, 23.9%; P = .31).

IN PRACTICE:

“Our findings provide strong real-world evidence supporting the obstetric safety of biologic therapy in psoriasis, including TNF inhibitors and newer IL-17 and IL-23 inhibitors,” the authors wrote. These results, they pointed out, “support guideline recommendations favoring continuation or selection of pregnancy-compatible biologic therapy for women planning conception or presenting with active psoriasis during pregnancy.” Considering the increased use of systemic therapy among reproductive-age women, they added, “further prospective registry data and mechanistic studies are needed to evaluate whether biologic-mediated control of systemic inflammation directly contributes to improved pregnancy outcomes.”

SOURCE:

The study was led by Danielle Bar, MD, Department of Dermatology, Gray Faculty of Medical and Health Sciences, Tel-Aviv University, Tel-Aviv, Israel, and was published online on June 5 in the Journal of the American Academy of Dermatology.

LIMITATIONS:

Disease severity data were unavailable, which could have led to residual confounding. Some outcomes were rare, especially stillbirth and placenta previa, which widened confidence intervals and limited precision. In addition, biologic exposure duration and trimester-specific timing could not be fully verified, restricting assessment of exposure continuity across pregnancy.

DISCLOSURES:

No funding sources were reported for this study. The authors disclosed having no conflicts of interest related to this work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.