Pregnancy complications, treatment characteristics and birth outcomes in women with atopic dermatitis in Denmark

Abstract

Background The risk of prenatal, obstetric and birth complications in mothers with atopic dermatitis (AD), along with treatment use during pregnancy, is unknown. Objectives To examine the associations between prenatal, obstetric and birth complications in mothers with AD and describe the dermatologic care received during pregnancy. Methods Mother‐child pairs, in which the mother had a history of AD, were identified through the Danish Medical Birth Registry and matched 1 : 10 with non‐AD pairs. Data on dermatologic treatment and prenatal, obstetric and birth complications were obtained through linkage via nationwide registers. Multiple logistic regression was performed. Results We identified 10 668 births from 1997 through 2014 to women with AD. Women with a hospital/ambulatory contact for AD during pregnancy had increased topical corticosteroid and ultraviolet therapy use during pregnancy compared to prior. However, overall, women with AD received decreased dermatologic therapy during pregnancy compared to prior. In adjusted analysis, maternal AD was inversely associated with gestational diabetes [OR 0.79, 95% CI (0.68–0.92)], but positively associated with premature rupture of membranes [1.15 (1.05–1.27)] and staphylococcal neonatal septicemia [2.45 (1.33–4.49)]—albeit the latter was rare. These associations did not meet statistical significance in sub‐analysis where body mass index data were available. No associations were found with preeclampsia, prematurity or non‐staphylococcal neonatal septicaemia. Conclusions Women with AD during pregnancy mainly used topical corticosteroids and ultraviolet therapy to control their disease. While premature rupture of membranes and staphylococcal neonatal septicaemia were over‐represented in maternal AD, no associations were found with any other significant prenatal, obstetric or birth outcome.

European task force on atopic dermatitis position paper: treatment of parental atopic dermatitis during preconception, pregnancy and lactation period

“…As some recommendations tend to suggest limiting or avoiding active therapy preconceptionally, prenatally and during lactation, physicians are sometimes too restrictive in prescribing both topical and systemic treatments during these periods. This observation was recently supported in a registry study from Denmark, where less potent topical steroids were used during pregnancy compared with before pregnancy . This may result in inadequate control of AD, potentially leading to flares and infections, and may have a detrimental effect on the health of women during pregnancy as well as a serious impact on sexual health …”

“…The data did not show whether this decrease was due to resolution of dermatitis or resulted from a tapering off of treatment due to concerns about adverse drug reactions during pregnancy. However, increased use of prednisolone in this cohort during pregnancy could indicate that some patients may have been undertreated and therefore needed rescue therapy with a systemic drug …”

“…Little is known about treatment patterns during pregnancy, but patients and caregivers tend to reduce the use of topical and systemic therapies during pregnancy to avoid presumed harm to the fetus. Indeed, a recent Danish register‐based study showed that ultraviolet therapy was particularly prevalent in the AD group during pregnancy, because it is considered a non‐invasive treatment . Moreover, pregnant AD women had overall reduced consumption of both topical and systemic medications when compared to the period prior to their pregnancy.…”

“…"Atopic eruption of pregnancy" (AEP) is the most common specific pregnancy dermatosis, accounting for 50% of patients seen for skin rash during pregnancy. 3 AEP may occur as a result of natural maternal T helper (Th) cell deviation during pregnancy. Most patients with AEP (80%) have no AD history or have had it in childhood only, supporting the idea that AEP may be an independent eczematous disease distinct from AD, although there are currently very limited insights into its pathogenesis.…”

“…This observation was recently supported in a registry study from Denmark, where less potent topical steroids were used during pregnancy compared with before pregnancy. 3 This may result in inadequate control of AD, potentially leading to flares and infections, and may have a detrimental effect on the health of women during pregnancy as well as a serious impact on sexual health. 5 Recently, in a critical appraisal of the topic, the evidence of pregnancy and fetal outcomes after paternal exposure to azathioprine, methotrexate or mycophenolic acid was summarized; however, the literature was very sparse and mainly of an observational character.…”