Maternal Hidradenitis Suppurativa Linked to Pregnancy Complications, Morbidity

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Maternal hidradenitis suppurativa (HS) is associated with an increased risk of pregnancy complications and adverse outcomes for mothers and offspring, according to findings from a recent study.¹

The longitudinal retrospective cohort study leveraged data for more than 1 million deliveries in hospitals in Quebec, Canada, and found pregnant patients with HS were at risk of hypertensive disorders of pregnancy, gestational diabetes, and other complications at delivery, while neonates were at risk of preterm birth and birth defects. After delivery, maternal HS continued to be associated with a wide range of morbidities for both mothers and their offspring.¹

A chronic inflammatory skin condition characterized by painful lesions, the impact of HS spans beyond physical discomfort, with associated pain, drainage, malodor, and scarring frequently leading to negative psychosocial implications for affected individuals, which is further exacerbated by frequent delays in diagnosis. HS more frequently affects women and its onset is most frequently between ages 21 to 29.²

“Hidradenitis suppurativa disproportionately affects persons of reproductive age, but the impact on maternal and offspring health is unclear,” Kaiyang Li, BSc, a medical student at McGill University, and colleagues wrote.¹ “Few studies have examined the effect of HS on maternal and offspring outcomes.”

To address this gap in research, investigators conducted a population-based longitudinal cohort study of deliveries in hospitals in Quebec, Canada, between April 1, 2006, and March 31, 2022. Data were obtained from the Maintenance and Use of Data for the Study of Hospital Clientele registry, which includes discharge records for all hospitalizations in Quebec and comprises 98% of births in Quebec.¹

The exposure measure in the study was maternal HS, identified using ICD-10 codes. Investigators included patients with HS requiring hospital treatment before, during, or after pregnancy as well as patients with a diagnosis of HS in the prenatal chart. These individuals were compared with pregnant persons with no record of HS in the prenatal chart or during other hospitalizations.¹

There were 4 categories of outcomes in this study: maternal pregnancy outcomes; neonatal outcomes at birth; maternal outcomes up to 16 years after delivery; and child outcomes up to 16 years after birth. Investigators used diagnostic codes from the ICD-10 and procedure codes from the Canadian Classification of Health Interventions to identify these outcomes.¹

In total, there were 1,324,488 deliveries during the study period, including 1332 (0.1%) among mothers with HS. Compared with unexposed patients, investigators noted mothers with HS were more likely to be younger than 25 years of age (23.6% vs 14.8%; P <.001), have comorbidity at the time of pregnancy (22.4% vs 7.4%; P <.001), and be socioeconomically disadvantaged (29.4% vs 20.3%; P <.001).¹

Upon analysis, compared with patients without HS, those with HS had an increased risk of hypertensive disorders of pregnancy (risk ratio [RR], 1.55; 95% CI, 1.29-1.87), gestational diabetes (RR, 1.61; 95% CI, 1.40-1.85), and severe maternal morbidity (RR, 1.38; 95% CI, 1.03-1.84). Additionally, HS was associated with cesarean delivery (RR, 1.18; 95% CI, 1.07-1.30), postpartum hemorrhage (RR, 1.49; 95% CI, 1.27-1.76), peripartum sepsis (RR, 2.71; 95% CI, 1.30-5.67), and ICU admission (RR, 2.64; 95% CI, 1.64-4.25).¹

In neonates, investigators pointed out maternal HS was associated with an increased risk of preterm birth (RR, 1.28; 95% CI, 1.07-1.53) and birth defects (RR, 1.29; 95% CI, 1.07-1.56), especially congenital heart defects (RR, 1.57; 95% CI, 1.01-2.43) and orofacial clefts (RR, 4.27; 95% CI, 1.84-9.92).¹

Additional analysis of long-term outcomes revealed mothers with HS had 2.29 times the risk of hospitalization later in life (95% CI, 2.07-2.55) and their children had 1.31 times the risk of hospitalization (95% CI, 1.18-1.45), including hospitalization for respiratory, metabolic, psychiatric, and immune-related morbidity over time.¹

Investigators acknowledged multiple limitations to these findings, some of which included the potential for nondifferential misclassification or random coding errors; undocumented or mild HS cases that did not require inpatient care and were subsequently missed; the lack of generalizability to mild HS; and the inability to infer a causal effect of HS due to the observational nature of the data.¹

“This longitudinal population-based cohort study of 1.3 million deliveries suggested that maternal HS was associated with an elevated risk of pregnancy complications and adverse outcomes in mothers and offspring in the peripartum period and later in life,” investigators concluded.¹ “Given the rate of adverse outcomes, clinicians should consider monitoring pregnant patients with HS more closely and following offspring over time to improve outcomes.”

References

1. ^{Li K, Piguet V, Croitoru D, et al. Hidradenitis Suppurativa and Maternal and Offspring Outcomes. JAMA Dermatol. Published online October 16, 2024. doi:10.1001/jamadermatol.2024.3584}
2. ^{Ballard K, Shuman VL. Hidradenitis Suppurativa. StatPearls. May 6, 2024. Accessed November 1, 2024. https://www.ncbi.nlm.nih.gov/books/NBK534867/}