Women with Alopecia Areata Have an Increased Chance of Poor Pregnancy Outcomes

One of the World’s First studies of Pregnancy Outcomes in Alopecia Areata

Alopecia areata is a systemic disease. A number of cytokines are increased in the blood of patients with alopecia areata - and the exact magnitude that cytokines are increased has some prognostic significance. For example studies have shown that the levels of TNF-α and IL-17 are positively correlated with disease severity, and cyototines like IL-2 and IL-22 are positively correlated with disease duration. It’s clear that systemic inflammation is very relevant to alopecia areata.

These cytokine changes have the potential to impact pregnancy outcomes. For example, it’s well known that patients with several autoimmune diseases like systemic lupus, rheumatoid arthritis and ulcerative colitis have worse outcomes during pregnancy than women who do not have these diseases.

Today, I would like to review with you a very important new study examining whether women with alopecia areata have similar or different pregnancy outcomes compared to control patients.

Cho et al 2021

Authors used the Korean National Health Insurance claims database to investigate the association between AA and obstetric complications.

Authors identified 4,552 patients with alopecia areata and compared data to 508,345 individuals without alopecia areata (control population).

After the authors used statistical analyses to adjust data for age, comorbidities, and obstetric and gynecological diseases, they found that :

the total live birth rate was significantly lower in patients with alopecia areata compared to controls (73.31 % vs 76.35%)

the rate of miscarriage was significantly higher in patients with alopecia areata compared to controls (17.55 % vs 16.33%)

the rate of ectopic pregnancy was significantly higher in patients with alopecia areata compared to controls (5.69% vs 4.48%)

more women with alopecia areata had a history of pelvic inflammatory disease compared to controlsl

there were no differences in rates of cesarean deliveries, stillbirths or infertility

Summary

All in all, this was an interesting study that suggests that patients with alopecia have a slightly higher chance of worse pregnancy outcomes. Specifically, patients have a higher chance of miscarriage, and a higher chance of having an ectopic pregnancy.

It is true that patients with alopecia areata have many comorbidities that can influence pregnancy outcomes like thyroid disease. IN fact, even in this study it was discovered that women with alopecia areata had higher rates of autoimmune hyperthyroidism and hypothyroidism, systemic lupus rates, and pelvic inflammatory disease (PID). However, even after adjusting for all these comorbidities, there were significantly fewer live births among patients with AA compared to controls.

This tells us that there is something very specific to having alopecia areata that influences these pregnacny outcomes as opposed to everything just being explained by thyroid disease or pelvic inflammatory disease or lupus.

This study could not assess whether severity of alopecia areata affected outcomes. So we don’t know if women with more severe AA have worse outcomes than patients with less severe alopecia areata. We also don’t know if treatment of the alopecia areata affects pregnancy outcomes. Theoretically, one can hypothesize than by reducing the levels of pro-inflammatory cytokines that this might be associated with improved pregnancy outcomes. We don’t know this and in fact, many alopecia areata medications are typically stopped in pregnancy given their potential to harm the fetus.

This study is important as it provides new understanding of the impact of having alopecia areata on pregnancy outcomes. Some of these risks are small meaning that most women with alopecia areata will still have healthy pregnancies and give birth to healthy babies. However, there is a slight risk of negative ooutcomes.

REFERENCE

Cho S et al. Pregnancy Outcomes in Female Patients with Alopecia Areata: A Nationwide Population-Based Study. J Invest Dermatol. 2021 Jul;141(7):1844-1847.e4.