A recent longitudinal cohort study from Canada has revealed that maternal hidradenitis suppurativa (HS) is associated with various complications during pregnancy, along with long-term health issues for both mothers and their children. Conducted by Dr. Nathalie Auger and her team at McGill University, the study, published in JAMA Dermatology, indicates that women with HS face a heightened risk of hypertensive disorders (risk ratio [RR] 1.55), gestational diabetes (RR 1.61), and severe maternal morbidity (RR 1.38) during the peripartum period.
Furthermore, HS is correlated with adverse neonatal outcomes, including an increased likelihood of preterm births (RR 1.28) and congenital anomalies (RR 1.29). Long-term follow-up data also show that mothers diagnosed with HS have more than double the risk of hospitalization (hazard ratio [HR] 2.29), particularly for respiratory, cardiovascular, and metabolic issues. Additionally, their children exhibit a significantly higher risk of hospitalization (RR 1.31), covering various health categories such as metabolic and developmental conditions.
The findings underscore the need for early detection and management of HS to mitigate these risks. Dr. Afsaneh Alavi from the Mayo Clinic noted that similar trends have been observed in other inflammatory skin diseases. Given that HS predominantly affects women of childbearing age, Alavi advocates for specialized evaluation and interdisciplinary monitoring for these patients during pregnancy.
Dr. Shoshana Marmon from New York Medical College emphasized the critical role of multidisciplinary care in improving outcomes for women with HS. She noted the surprising increase in preterm births, suggesting that chronic inflammation may play a role in early labor. The study also highlights a threefold increased risk of infection (HR 3.37) and a fourfold risk of allergy-related hospitalizations (RR 4.02) among affected mothers.
The study utilized a comprehensive Quebec registry that tracked hospitalization records of 1,324,488 deliveries from 2006 to 2022, identifying 1,332 mothers (0.1%) with HS. Compared to their peers, mothers with HS were more likely to be under 25 years old, have pre-existing health conditions, and come from socioeconomically disadvantaged backgrounds.
In addition to the previously mentioned complications, mothers with HS showed increased risks for peripartum sepsis (RR 2.71), ICU admissions (RR 2.64), cesarean deliveries (RR 1.18), and postpartum hemorrhage (RR 1.49). However, no significant associations were found with placental complications.
Neonatal outcomes associated with maternal HS included congenital heart defects (RR 1.57) and orofacial clefts (RR 4.27). Notably, the study found no significant links between HS and respiratory distress syndrome or severe neonatal morbidity.
The researchers speculated that the chronic inflammation characteristic of HS may underlie these adverse outcomes, referencing elevated cytokines associated with conditions like preeclampsia and gestational diabetes. They acknowledged potential limitations in their data, including the possibility of misclassification and the focus on severe HS cases, which may not represent the broader population.
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