Pregnancy outcomes in patients with biologic-exposed psoriasis: A large cohort study of real-world safety

BACKGROUND: Pregnancy safety data for biologic therapies in psoriasis remain limited. OBJECTIVE: To compare overall and individual adverse pregnancy outcomes (APOs) between reproductive-age women with psoriasis exposed to biologic agents and unexposed psoriasis controls. METHODS: We performed a cohort study including females aged 15 to 49 years exposed to biologics during pregnancy. APOs were compared between biologic-exposed pregnancies and unexposed psoriasis controls. RESULTS: A total of 1226 biologic-exposed psoriasis patients and 1238 unexposed psoriasis controls were included. Any APO occurred in 24.1% of biologic-exposed patients versus 30.0% of unexposed controls (OR 0.76; 95% CI, 0.64-0.89; P = .0013). Biologics were associated with lower odds of spontaneous abortion (8.40% vs 10.90%; OR 0.75; 95% CI, 0.57-0.98; P = .0406), gestational diabetes mellitus (4.16% vs 7.43%; OR 0.54; 95% CI, 0.38-0.77; P = .00,054), and any APO overall. LIMITATIONS: Retrospective design, limited power for non-TNF-α biologic subclasses, and incomplete characterization of trimester-specific exposure duration. CONCLUSIONS: Biologic-exposed psoriasis patients did not exhibit increased risk of any adverse pregnancy outcome compared with unexposed controls.