Synopsis The evidence to date regarding corticosteroid exposure in pregnancy and select pregnancy and birth outcomes is limited and inconsistent. Here we provide a narrative review of published literature summarizing the findings for oral clefts, preterm birth, birth weight, preeclampsia and gestational diabetes mellitus. Whenever possible, the results are limited to oral or systemic administration with a further focus on use in autoimmune disease. Although previous studies of corticosteroid exposure in pregnancy reported an increased risk of oral clefts in the offspring, more recent studies have not replicated these findings. Further, most of the literature lacks robust statistical analysis accounting for underlying disease or disease activity. The evidence to date suggests that first trimester corticosteroid use may confer a small increase in the odds of cleft lip with or without cleft palate, although data are conflicting and it is unknown to what extent the underlying maternal disease may contribute. There is little support that systemic corticosteroid use in pregnancy independently causes increases in risks of preterm birth, low birth weight, or preeclampsia. There is not sufficient evidence to determine whether corticosteroids could contribute to gestational diabetes mellitus.

SummaryBackground Data on pregnancy outcomes among women with psoriasis are lacking. However, there are several known comorbidities of psoriasis, including obesity, smoking and depression, each of which increases the risk for negative birth outcomes. Objectives To determine if pregnant women with psoriasis have an excess of potentially modifiable risk factors for adverse pregnancy outcomes. Methods Prospectively collected data from the Organization of Teratology Information Specialists (OTIS) Autoimmune Diseases in Pregnancy Project were analysed to compare the prevalence of selected risk factors between 170 pregnant women with psoriasis and 158 nondiseased controls. Results Women with psoriasis were more likely to be overweight ⁄obese prior to pregnancy (P < 0AE0001), to smoke (P < 0AE0001), or to have a diagnosis of depression (P = 0AE03), and were less likely to have been taking preconceptional vitamin supplements (P = 0AE004). After controlling for race ⁄ethnicity and socioeconomic status, women with psoriasis were 2AE37 (95% confidence interval 1AE45-3AE87) times more likely to be overweight ⁄obese as women without psoriasis. Duration of disease, age at onset, measures of disease impact during pregnancy, or use of biologics in pregnancy were not significant predictors of overweight ⁄obesity in the subset of psoriatic women. Conclusions Pregnant women with psoriasis may be at increased risk for adverse pregnancy outcomes due to comorbidities or other health behaviours associated with the disease. These should be taken into consideration during clinical treatment of women with psoriasis who are in their childbearing years.

Background The stress sensitization theory hypothesizes that individuals exposed to childhood adversity will be more vulnerable to mental disorders from proximal stressors. We aimed to test this theory with respect to risk of 30-day major depressive episode (MDE) and generalized anxiety disorder (GAD) among new U.S. Army soldiers. Methods The sample consisted of 30,436 new soldier recruits in the Army Study to Assess Risk and Resilience (Army STARRS). Generalized linear models were constructed, and additive interactions between childhood maltreatment profiles and level of 12-month stressful experiences on the risk of 30-day MDE and GAD were analyzed. Results Stress sensitization was observed in models of past 30-day MDE (χ28=17.6, p=0.025) and GAD (χ28=26.8, p=0.001). This sensitization only occurred at high (3+) levels of reported 12-month stressful experiences. In pairwise comparisons for the risk of 30-day MDE, the risk difference between 3+ stressful experiences and no stressful experiences was significantly greater for all maltreatment profiles relative to No Maltreatment. Similar results were found with the risk for 30-day GAD with the exception of the risk difference for Episodic Emotional and Sexual Abuse, which did not differ statistically from No Maltreatment. Conclusions New soldiers are at an increased risk of 30-day MDE or GAD following recent stressful experiences if they were exposed to childhood maltreatment. Particularly in the military with an abundance of unique stressors, attempts to identify this population and improve stress management may be useful in the effort to reduce the risk of mental disorders.

Women with RA and JIA are at increased risk for PTD. Maternal disease activity and corticosteroid use may contribute to some of this excess risk. This article is protected by copyright. All rights reserved.

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