- Design
- Retrospective cohort
- Population
- 1,226 biologic-exposed and 1,238 unexposed pregnancies in women aged 15–49 with psoriasis
- Primary outcome
- Any adverse pregnancy outcome
- Effect
- 24.1% vs 30.0%; OR 0.76 (95% CI 0.64 to 0.89)
This retrospective cohort, published in June, compared 1,226 pregnancies in women with psoriasis exposed to biologics with 1,238 pregnancies in women with psoriasis who were not exposed.
Any adverse pregnancy outcome occurred in 24.1% of exposed and 30.0% of unexposed pregnancies (OR 0.76, 95% CI 0.64 to 0.89). Miscarriage (8.4% vs 10.9%) and gestational diabetes (4.2% vs 7.4%) were less common with biologics.
The lower rates are unlikely to mean biologics protect pregnancy. Better-controlled psoriasis, and differences between women who stay on treatment and those who stop, are more plausible explanations. What matters is that there was no excess of harm. The study had little power for biologic classes other than TNF inhibitors, and trimester timing was incompletely recorded.
For women of reproductive age with severe psoriasis, this supports discussing continuation of a biologic in pregnancy rather than stopping by default, with the choice of agent and timing planned jointly with obstetrics.
- Discuss pregnancy plans with every woman of reproductive age starting a biologic
- Consider continuing a biologic in pregnancy where psoriasis is severe, rather than stopping by default
- Plan agent choice with obstetrics; data were strongest for TNF inhibitors
- Tell paediatricians about third-trimester biologic exposure before infant live vaccines
- Data for IL-17 and IL-23 inhibitors in pregnancy remain limited
Why it matters
It challenges the habit of stopping biologics at conception and risking a severe flare in pregnancy.
Don't overread it
This is observational; it shows no excess harm, not that biologics improve pregnancy outcomes.
The statistics, in plain English
An odds ratio of 0.76 with a confidence interval of 0.64 to 0.89 excludes 1.0, so exposed pregnancies had fewer adverse outcomes. In an observational study this lower rate most likely reflects disease control and confounding, not a protective drug effect.
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