Maternal Hidradenitits Suppurativa Linked to Neonatal Mortality, Pediatric Hospitalization Risk

Children born to mothers with hidradenitis suppurativa (HS) face more than two-fold increased risk of neonatal death and metabolic hospitalization, among a number of other severe outcomes, to new data.

In new research presented at the American Academy of Dermatology (AAD) 2024 Annual Meeting in San Diego, CA, this week, a team of Canada-based investigators observed a 31% increased risk of hospitalization among children born to mothers with HS versus those not exposure to the chronic skin disease in utero. The findings also showed a significantly increased risk of childhood morbidity among HS-exposed infants in a number of other conditions—from mental and behavioral disorders, to gastrointestinal complications.

Led by Kaiyang Li, BSc, a third-year medical student at McGill University, investigators sought to estimate the associated risk of childhood hospitalization through age 16 relative to maternal hidradenitis suppurativa. The team noted that the link between HS and adverse pregnancy outcomes has been previously established—albeit without knowing the effect such exposure has on the offspring.

Their retrospective longitudinal cohort study included more than 1.2 million children born from April 2005 – March 2022 in Quebec, Canada. Of the pool, the team identified 1283 children whose mothers known HS. They estimated hazard ratios (HRs) for outcomes including respiratory, cardiovascular, metabolic, and other conditional morbidity in children up to age 16.

Regarding hospitalizations, Li and colleagues observed a 45% increased rate of hospitalization (53.2 per 1000 person years [95% CI, 48.3 – 58.5]) among children exposed to HS versus those not exposed (36.6 per 1000 [95% CI, 36.5 – 36.8]). Along with a 31% increased risk of hospitalization, investigators observed the following long-term risks:

• Respiratory hospitalization (HR, 1.21; 95% CI, 1.05 – 1.40)
• Metabolic hospitalization (HR, 2.64; 95% CI, 1.67 – 4.20)
• Gastrointestinal hospitalization (HR, 1.34; 95% CI, 1.03 – 1.74)
• Developmental hospitalization (HR, 1.92; 95% CI, 1.43 – 2.58)

Perhaps more concerning, investigators observed a doubled risk of neonatal death, as well as the following infant outcomes:

• Preterm birth (relative risk [RR], 1.29; 95% CI, 1.08 – 1.55)
• Birth defects (RR, 1.29; 95% CI, 1.07 – 1.56)
• Congenital heart defects (RR, 1.57; 95% CI, 1.02 – 1.44)
• Orofacial clefts (RR, 4.29; 95% CI, 1.85 – 9.97)

In an interview with HCPLive at AAD 2024, Li discussed the team’s findings at length, including potential drivers of these observed associations—including chronic inflammation’s role in pregnancy complciations.

“There’s also the comorbidities,” Li said. “HS is one of those skin disorders that’s associated with a lot of medical comorbidities, and even just potential teratogenic risk associated with HS medications—like antibiotics or biologics—sometimes people don’t know they’re pregnant yet and there could be a link to that as well.”

Regarding the long-term outcomes in pediatric patients, Li said it is understood that endocrinological imbalances including obesity or polycystic ovary syndrome (PCOS) are commonly linked to HS; these same prenatal exposures may impact neurological development of the fetus.

“So that might have played a role as well in why those babies are at high risk of all these immunological morbidities later on in life,” Li said. “Apart from that, there’s also genetic predisposition.”

Li additionally reviewed potential genetic and environmental factors that which may have contributed to the disparate outcomes among children exposed to maternal HS. All the same, the team concluded it remains a finding that warrants further analysis.

^Reference

^{Li K, Wei SQ, Brousseau E, O’Brien E, et al.Effect of maternal hidradenitis suppurativa on offspring outcomes: A longitudinal cohort study. Poster presented at: American Academy of Dermatology (AAD) 2024 Annual Meeting. March 8 – 12, 2024. San Diego, CA.}