Chronic Skin Condition Tied to Host of Health Risks for Mother and Child

Maternal hidradenitis suppurativa (HS) was associated with complications during pregnancy as well as long-term maternal and child morbidity, a longitudinal cohort study from Canada showed.

In the peripartum period, women with HS had a higher adjusted 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) compared with peers without HS.

Maternal HS was also tied to worse neonatal outcomes, namely more preterm births (RR 1.28, 95% CI 1.07-1.53) and birth defects (RR 1.29, 95% CI 1.07-1.56), reported Nathalie Auger, MD, MSc, of McGill University in Montreal, and co-authors in JAMA Dermatology.

In long-term follow-up, affected mothers had more than double the risk of hospitalization (HR 2.29, 95% CI 2.07-2.55), especially for respiratory (HR 3.20, 95% CI 2.59-3.95), cardiovascular (HR 3.09, 95% CI 2.36-4.05), and metabolic (HR 5.05, 95% CI 3.37-7.56) reasons.

Additionally, their children were also significantly more likely to require a childhood hospitalization in the long run (RR 1.31, 95% CI 1.18-1.45), according to Auger’s group. These included excess metabolic, central nervous system, developmental, and musculoskeletal hospitalizations.

“This cohort study found that HS is associated with adverse maternal and offspring outcomes in the peripartum period and in the long term. Early detection and management of HS may help mitigate these outcomes,” the authors concluded.

HS is a chronic skin condition that causes skin abscesses and follicular lesions, usually in areas near sweat glands.

The present findings reflect similar reports seen in other inflammatory skin disease, commented Afsaneh Alavi, MD, a dermatologist at the Mayo Clinic in Rochester, Minnesota, who was not involved with the study.

As HS disproportionately affects women — particularly women of childbearing age — these patients are urged for evaluation by specialized clinics familiar with high-risk pregnancy, and closely monitored by an interdisciplinary team, according to Alavi.

Dermatologist Shoshana Marmon, MD, PhD, of New York Medical College in Valhalla, similarly stressed “the importance of multidisciplinary care” and “enhanced monitoring during pregnancy” to improve outcomes in women with HS.

“The unexpected increased risk of preterm birth suggests that chronic inflammation or immune dysregulation from HS may contribute to early labor,” Marmon told MedPage Today. “Additionally, the increased risk of infections calls for closer monitoring and potential prophylactic care, particularly near delivery. Targeted screening can help prevent or reduce complications for both mother and baby.”

Among the mothers, Auger’s group found that HS was associated with a threefold higher risk of infection (HR 3.37, 95% CI 2.86-3.99) and a fourfold higher risk of allergy hospitalizations (RR 4.02, 95% CI 2.62-6.17).

For their observational cohort study, Auger and colleagues used a Quebec registry providing discharge records for all hospitalizations in the province. This included maternal and neonatal outcomes of 1,324,488 deliveries in Quebec with a maximum follow-up spanning 2006 to 2022; a total of 1,332 mothers (0.1%) had a diagnosis of HS.

Compared with unexposed patients, mothers with HS were significantly more likely to be younger than 25 years (23.6% vs 14.8%), have a comorbidity at the time of pregnancy (22.4% vs 7.4%), and be socioeconomically disadvantaged (29.4% vs 20.3%), Auger and co-authors wrote.

Parity and year of delivery were similar between the two groups.

Besides the aforementioned adverse maternal peripartum outcomes of HS, Auger’s group also reported increased risks of peripartum sepsis (RR 2.71, 95% CI 1.30-5.67), ICU admission (RR 2.64, 95% CI 1.64-4.25), cesarean delivery (RR 1.18, 95% CI 1.07-1.30), and postpartum hemorrhage (RR 1.49, 95% CI 1.27-1.76). Authors noted no associations with placental complications, such as placenta previa, accreta, and abruption.

As for neonatal outcomes, maternal HS was associated with congenital heart defects (RR 1.57, 95% CI 1.01-2.43) and orofacial clefts (RR 4.27, 95% CI 1.84-9.92). There were no significant links between maternal HS and respiratory distress syndrome, severe neonatal morbidity, or neonatal ICU admission.

The researchers acknowledged that the mechanisms behind the adverse birth outcomes in women with HS are unclear, but theorized that the chronic inflammation that characterizes HS is involved.

“Patients with HS have elevated levels of interleukin-1β and tumor necrosis factor-α, cytokines implicated in preeclampsia, gestational diabetes, and preterm birth among patients with rheumatoid arthritis and psoriasis,” they explained.

Auger’s team also cautioned that their registry data may have been subject to misclassification or coding errors. The analysis also relied on hospitalization records primarily capturing patients with severe HS, so their report may not necessarily be generalizable to mild HS.

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