Abstract

Giriş: Bu çalışmanın amacı, psöriatik artriti (PsA) olan kadınlarda obstetrik ve neonatal sonuçları değerlendirmek; tanı öncesi ve sonrası gebelikleri sağlıklı kontrollerle karşılaştırmak ve hastalık aktivitesi, tedavi kullanımı ve alevlenmelere odaklanmaktır. Materyal ve Method: Bu retrospektif kesitsel çalışmaya, PsA tanılı 85 kadından 227 gebelik ve 46 sağlıklı kadından 100 gebelik dahil edilmiştir. Preeklampsi, gestasyonel hipertansiyon, gestasyonel diyabet, sezaryen doğum, preterm doğum, gebelik haftasına göre küçük bebek (SGA), konjenital anomaliler ve yenidoğan yoğun bakım ünitesine (YYBÜ) yatış gibi maternal ve neonatal sonuçlar değerlendirilmiştir. Gebelik sürecinde hastalık aktivitesi ve alevlenmeler kayıt altına alınmıştır. Komposit adverse maternal ve neonatal sonuçları öngören faktörleri belirlemek için lojistik regresyon analizi yapılmıştır. Bulgular: PsA gebeliklerinin 161’i (%71) tanıdan önce, 66’sı (%29) tanıdan sonra gerçekleşmiştir. Tanı sonrası gebeliklerde anne yaşı daha yüksek olup, bu gebeliklerde sezaryen oranı (%60.4’e karşı %16.9 ve %14.5, p < 0.001), preeklampsi (%11.3’e karşı %0.7, p < 0.001), gestasyonel diyabet (%11.3’e karşı %2.9, p = 0.03) ve gestasyonel hipertansiyon (%11.3’e karşı %7.4 ve %2.4, p = 0.03) anlamlı olarak daha yüksek bulunmuştur. Komposit adverse maternal sonuçlar da tanı sonrası gebeliklerde, hem tanı öncesi gebeliklere hem de kontrol grubuna göre daha sık görülmüştür. Neonatal sonuçlarda ise SGA, tanı sonrası gebeliklerde anlamlı olarak daha fazladır (%17’ye karşı %6.6 ve %2.4; p = 0.02 ve p = 0.002). YYBÜ yatışı tanı sonrası gebeliklerde tanı öncesine kıyasla artmıştır (%18.9’a karşı %6.6; p = 0.01). Lojistik regresyon analizinde ileri anne yaşı, olumsuz maternal sonuçların bağımsız bir belirleyicisi olarak saptanmış; neonatal sonuçlar için bağımsız bir öngörücü bulunmamıştır. Sonuç: PsA’lı gebeliklerde özellikle tanı sonrasında maternal olumsuz sonuçlar daha sık görülmektedir. Neonatal sonuçlar genel olarak kontrollerle benzer olmakla birlikte, SGA sıklığı tanı sonrası gebeliklerde artmıştır. İleri anne yaşı, hastalık aktivitesi ve tedaviye maruziyetin etkileri dikkate alındığında, anne ve bebeğin en iyi sonuçlara ulaşabilmesi için yakın takip ve bireyselleştirilmiş gebelik yönetimi gereklidir.

Keywords

• Psöriatik artrit
• gebelik
• obstetrik sonuçlar
• neonatal sonuçlar
• hastalık aktivitesi

Psoriatic arthritis and pregnancy: maternal and neonatal outcomes in a clinical cohort

Abstract

Aims: To evaluate obstetric and neonatal outcomes in women with psoriatic arthritis (PsA) by comparing pregnancies before and after diagnosis, as well as with healthy controls, with a focus on disease activity, treatment exposure, and flares Methods: This retrospective cross-sectional study included 227 pregnancies from 85 women with PsA and 100 pregnancies from 46 healthy controls. Maternal and neonatal outcomes were assessed, including preeclampsia, gestational hypertension, gestational diabetes, cesarean delivery, preterm birth, small for gestational age (SGA), congenital anomalies, and neonatal intensive care unit (NICU) admissions. Disease activity and flares during pregnancy were recorded. Logistic regression analyses were performed to identify predictors of composite adverse maternal and neonatal outcomes. Results: Among PsA pregnancies, 161 (71%) occurred before and 66 (29%) after diagnosis. Maternal age at conception was higher post-diagnosis, and these pregnancies showed increased rates of cesarean delivery (60.4% vs. 16.9% and 14.5%, p<0.001), preeclampsia (11.3% vs. 0.7%, p<0.001), gestational diabetes (11.3% vs. 2.9%, p=0.03), and gestational hypertension (11.3% vs. 7.4% and 2.4%, p=0.03). Composite adverse maternal outcomes were more frequent after PsA diagnosis compared with both pre-diagnosis pregnancies and controls. For neonatal outcomes, SGA was significantly more common after diagnosis (17% vs. 6.6% and 2.4%, p=0.02 and p=0.002), and NICU admissions were increased compared with pre-diagnosis pregnancies (18.9% vs. 6.6%, p=0.01). Logistic regression identified advanced maternal age as an independent predictor of adverse maternal outcomes, whereas no independent predictors were found for neonatal outcomes. Conclusion: In pregnancies with PSA, adverse maternal outcomes are more frequent, especially after diagnosis, whereas neonatal outcomes are generally comparable to control groups, with an increased frequency of SGA. Given the impact of advanced maternal age, disease activity, and treatment exposure, close monitoring and individualized management are necessary to achieve the best outcomes for both mother and baby.

Keywords

• Psoriatic arthritis
• pregnancy
• obstetric outcomes
• neonatal outcomes
• disease activity

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