Impact of Pregnancy on Hidradenitis Suppurativa Disease Course: A Systematic Review and Meta-Analysis

Abstract

<b><i>Background:</i></b> Hormones are thought to play a role in hidradenitis suppurativa (HS). However, data on the HS disease course during pregnancy and the postpartum period has not been well established. The objective of this study is to analyze the available literature to determine HS disease activity during pregnancy and the postpartum period. <b><i>Methods:</i></b> The PubMed and Embase databases were systematically searched for relevant articles from database inception until November 22, 2020. The inclusion criteria were a study population with the diagnosis of HS and discussion of pregnancy impact on the HS disease course or postpartum flare. Study characteristics, patient demographics, HS severity, and HS disease course during pregnancy and the postpartum period were extracted by 2 independent reviewers. The quality of included studies was assessed using the Newcastle-Ottawa Scale for observational studies. Heterogeneity was assessed using Cochran’s Q statistic and <i>I</i><sup>2</sup> index. The random-effects meta-analytical model was used. The primary study outcome was the pooled odds ratio of improvement or of worsening of HS disease activity during pregnancy. <b><i>Results:</i></b> The systematic search identified 8 studies for analysis. There was a total of 672 cases for which data on the patient-reported HS disease course during pregnancy were available, and 164 cases for which data on patient-reported postpartum flare were available. In the meta-analyses, the rate of HS disease improvement was 24% (95% CI 0.13–0.40) and the rate of HS disease worsening was 20% (95% CI 0.11–0.34). Sixty percent (99/164) of patients experienced a postpartum flare. <b><i>Conclusion:</i></b> While about a quarter of women will experience an improvement in HS during pregnancy, the majority will have a stable or worsened disease course, and over half of patients will experience a postpartum flare. Close monitoring of HS patients is needed during pregnancy and postpartum periods, as patients may need continued, or even escalated, disease management.

The Role of Hormones in Hidradenitis Suppurativa: A Systematic Review

“…Perimenstrually, 43–76.7% of patients report subjective worsening in HS [ 7 , 11 ]. A meta-analysis has shown that about 25% of the patients report improvement and 20% of the patients report worsening in HS during pregnancy [ 12 ]. However, about 60% of the patients show worsening in HS postpartum [ 12 ].…”

“…A meta-analysis has shown that about 25% of the patients report improvement and 20% of the patients report worsening in HS during pregnancy [ 12 ]. However, about 60% of the patients show worsening in HS postpartum [ 12 ]. All these results support the hormonal influence in HS.…”

“…As some patients demonstrate a link between HS and pregnancy, further investigation of progesterone levels during pregnancy and after pregnancy might be useful. Peripubertal onset of HS, premenstrual deterioration, and postpartum deterioration supported the role of sex hormones in HS [ 7 , 11 , 12 ]. However, this connection has not yet been proven.…”

Hidradenitis Suppurativa: The Influence of Gender, the Importance of Trigger Factors and the Implications for Patient Habits

“…A recent systematic review and meta-analysis (including 8 studies [ 53 , 143 , 144 , 145 , 146 , 147 , 148 , 149 ], 672 pregnancy cases and 164 postpartum cases) found that the patient-reported rates of HS improvement and HS disease worsening were 0.24 and 0.20, respectively. The percentage of patients reporting postpartum disease flare-up was 60% [ 150 ]. In their retrospective survey study, Prens and colleagues showed that 44.6%, 29.7% and 25.7% of patients experienced improvement (mostly in the first trimester), worsening (primarily in the third trimester) and no change in HS symptoms during pregnancy, respectively.…”

Reply to ‘Comment on ‘The effectiveness and safety of topical beta‐receptor blocker in treating superficial infantile haemangiomas: A meta‐analysis including 20 studies’ Dr. Sun et al.’

“…Many meta-analysis searched only two or three databases. [3][4][5][6][7][8] The heterogeneity of the studies in our meta-analysis may be caused by many factors, such as the dosage and application rates of medicinal treatment, formulations, dose concentrations and application rates of timolol. Due to the limited number of included studies, we did not perform a subgroup analysis.…”