Evaluation of Hidradenitis Suppurativa Disease Course During Pregnancy and Postpartum

Abstract

This cohort study examines changes in the disease course of hidradenitis suppurativa during pregnancy and postpartum. Question Are pregnancy and the postpartum period associated with changes in the disease course of hidradenitis suppurativa? Findings This cohort study of 202 pregnancies in 127 women found that patients had a high rate of hidradenitis suppurativa exacerbation during pregnancy and postpartum. Dermatologists were not involved in the management of care for most of these patients, and most patients did not receive hidradenitis suppurativa-directed medical or procedural treatment during pregnancy. Meaning Results of this study suggest that close multidisciplinary collaboration between dermatologists and their obstetrics-gynecology colleagues may help in the delivery of optimal care for patients with hidradenitis suppurativa during pregnancy and the postpartum period. Importance Hidradenitis suppurativa (HS) disproportionately affects women of childbearing potential. There is a paucity of data regarding the HS disease course during pregnancy and in the postpartum period. Objective To explore the HS disease course during pregnancy and in the postpartum period. Design, Setting, and Participants A retrospective cohort study was conducted on patients in the Henry Ford Health System, Detroit, Michigan-a large, academic, urban referral center. Women with a diagnosis of HS who became pregnant between January 1, 2008, and December 31, 2018, were included. International Classification of Diseases, Ninth Revision, and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, were used for identification of the diagnosis. Exposures Pregnancy in patients with HS. Main Outcomes and Measures Hidradenitis suppurativa disease status during pregnancy and the postpartum period. Results A total of 127 women with HS were included in this study and accounted for 202 pregnancies. Of the 202 pregnancies, 171 were in black women, 25 in white women, 3 in women of other race/ethnicity, and 3 had unreported data. Mean (SD) age at HS onset was 19.3 (5.6) years; at time of HS diagnosis, 24.4 (5.3) years; and at time of pregnancy, 25.9 (5.0) years. The disease worsened during pregnancy in 70 pregnancies (61.9%), did not change in 34 pregnancies (30.1%), and improved in 9 pregnancies (8.0%). Hidradenitis suppurativa exacerbated in the postpartum period after 82 of 124 pregnancies (66.1%). Dermatologists were involved in managing HS in 28 pregnancies (14.4%) and for a higher proportion of patients with more severe Hurley stage as compared with cases of mild disease (stage 3: 7 of 18 [38.9%] vs stage 1: 10 of 100 [10.0%] or stage 2: 11 of 67 [16.4%]; P = .004). In addition, HS medical treatment was administered during 77 pregnancies (38.1%), while HS procedural treatment was administered during 34 pregnancies (16.8%). A significantly higher proportion of patients whose care was managed by dermatologists vs those without dermatologist involvement received any HS medication (22 [78.6%] vs 53 [31.7%], P < .001) or any HS procedure (14 [50%] vs 19 [11.4%], P < .001) during pregnancy. Conclusions and Relevance Despite a high rate of HS exacerbation during pregnancy and postpartum, this cohort study found that most of the patients did not receive HS-directed medical treatment or care from a dermatologist during pregnancy. Close monitoring and improved collaborative care between dermatology and obstetrics-gynecology services is warranted.