Psoriasis Linked to Lower Fertility, Higher Rate of Pregnancy Loss

Though scientists aren't sure why women with psoriasis are more likely to experience fertility and pregnancy challenges, they say healthcare providers should be aware of the increased risk.

Psoriasis is an autoimmune inflammatory skin condition that causes the overproduction of skin cells. Symptoms of the disorder include thick, red areas on the skin that may crack and cause discomfort, fingernail issues, and joint pain.

Though other autoimmune and inflammatory disorders are known to impact pregnancy negatively, previous research investigating fertility and pregnancy outcomes in women with psoriasis has produced conflicting findings.

However, a new study published on June 7 in JAMA Dermatology has shed more light on the impact psoriasis may have on fertility and pregnancy.

To investigate whether psoriasis affects fertility rates and pregnancy loss, scientists from the University of Manchester, England, examined data between 1998 and 2019 from the UK Clinical Practice Research Datalink GOLD database linked to a pregnancy register and Hospital Episode Statistics.

The team used that data to compare 63,681 women with psoriasis to 318,405 matched controls without the skin condition. After analyzing records, they found that while participants with psoriasis appeared to have higher fertility rates than those without psoriasis, women with moderate to severe psoriasis had lower fertility rates.

In addition, participants with psoriasis had a higher risk of pregnancy loss due to miscarriage, ectopic, molar, blighted ovum, or any unspecified loss, than those without the condition.

"We found that pregnancy loss occurred in about 1 in 5 pregnancies in patients with psoriasis, and approximately 95% of these occurred in the first trimester, which was probably unavoidable due to chromosomal errors," the authors write.

Still, the data analysis shows no increased risks of antenatal hemorrhage, preeclampsia, or gestational diabetes in women with psoriasis.

The authors say the mechanisms behind the higher risk of pregnancy loss are unclear. However, psoriasis is characterized by the increased activity of IL-17, IL-23, and tumor necrosis factor α. Therefore, they suggest these proinflammatory cytokines may negatively affect the placenta and cause impaired fetal growth, leading to pregnancy loss.

But the analysis also found that compared with the matched controls, patients with psoriasis were more likely to be current smokers or alcohol drinkers or have an unhealthy weight. They were also more likely to have a mental health diagnosis of anxiety or depression.

The scientists say all these factors may play a role in fertility and pregnancy outcomes.

Still, the authors stress that more research is needed to explore these and other potential reasons why psoriasis appears to impact fertility and pregnancy.

Moreover, in light of these findings, the team suggests, "General practitioners in primary care, where the diagnosis of psoriasis may be missed and hence the treatment may be delayed, should be aware of the increased risk of early pregnancy loss, especially for younger patients with psoriasis."

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