Retrospective cohort study of pregnancy outcomes in hidradenitis suppurativa

Hidradenitis suppurativa (HS) disproportionately affects women of childbearing age; however, there has been a paucity of literature in the field of HS and pregnancy.1 The objective of this study was to examine pregnancy complications, pregnancy outcomes, and neonatal outcomes in patients with HS.

In addition, HS cohort percentages were compared with corresponding general US population percentages using one-sample χ 2 -tests. P-values < 0·05 were considered statistically significant. The study sample size resulted in a power of 0·80 to detect modest outcome differences of 12-18% for individual patient characteristics. All analyses were performed using SAS version 9·4 (SAS Institute, Cary, NC, USA).
In total 202 pregnancies in 127 patients with HS were included (Table 1). Tobacco and marijuana use was continued throughout 13·4% (n = 27) and 13·9% (n = 28) of pregnancies, respectively. Likelihood of miscarriage was not significantly associated with race, obesity at baseline, or Hurley stage. Presence of vulvar or groin HS lesions was not associated with a higher likelihood of C-section.
In over 10% of pregnancies in this cohort, patients continued to use tobacco and marijuana during pregnancy; therefore, strongly counselling patients with HS regarding cessation of smoking and recreational drug use during pregnancy is warranted. Additionally, a significantly higher proportion of patients with HS breast lesions did not breastfeed compared with those without HS breast lesions. This highlights the importance of anticipatory counselling regarding breastfeeding in patients with breast lesions.
Prior studies on other inflammatory diseases such as rheumatoid arthritis and systemic lupus erythematosus have shown that the disease influences rates of preterm birth and pregnancy loss. 2 No statistically significant differences were detected when comparing our study cohort with the general population of women in the US in terms of the rates of miscarriage, 3 Csection, 4 premature baby, 4 stillbirth 5 and perinatal mortality. 5 In addition, baseline HS disease severity was not significantly associated with poorer pregnancy or neonatal outcomes. Thus, our findings on pregnancy outcomes can help providers counsel and reassure concerned pregnant patients with HS regarding pregnancy outcomes. In contrast, compared with rates of gestational diabetes mellitus, 6 gestational hypertension 7 and preeclampsia 8 in the US general population, our study cohort had a higher than average rate for each condition, with statistical significance detected for gestational hypertension (P = 0·022) and pre-eclampsia (P = 0·017). Therefore, screening for these conditions among pregnant patients with HS is essential.
Study limitations include: that it took place at a single academic centre, was retrospective and contained missing data. Lack of systematic follow-up of neonatal charts could have resulted in underestimation of the perinatal mortality rate. Only univariate analysis was conducted; thus, potential confounders have not been controlled for.
In summary, our study suggests that HS does not portend an increased risk of poor pregnancy or neonatal outcomes. Large, prospective pregnancy registries are needed to collect data on maternal and neonatal outcomes in patients with HS.