Adverse pregnancy outcomes among pregnant women with hidradenitis suppurativa: A systematic review and meta-analysis

Background Hidradenitis suppurativa (HS) is a chronic inflammatory dermatosis primarily affecting women of reproductive age and may contribute to an increase of adverse pregnancy outcomes (APOs). Objective To investigate the association of HS with APOs. Methods A systematic review of observational studies examining the association of maternal HS with APOs was conducted. We searched MEDLINE, Embase, and CENTRAL from inception to 15 March 2025 for relevant studies. No restrictions were imposed on language or geographic regions. Observational studies, including cohort and case-control designs, which examined the odds or risk of APOs among pregnant women were considered eligible for inclusion. The risk of bias was assessed using the Newcastle-Ottawa Scale. A random-effects model meta-analysis using the inverse-variance-weighted method was performed. Results We included 4 retrospective cohort studies with 15,189,175 pregnancies. The overall risk of bias was low to unclear. The meta-analysis revealed associations of HS with APOs, including gestational diabetes mellitus (OR 1.46, 95% confidence interval [CI] 1.09-1.96), preeclampsia/eclampsia (OR 1.18, 95% CI 1.01-1.38), cesarean section (OR 1.31, 95% CI 1.04-1.64), and postpartum hemorrhage (OR 1.39, 95% CI 1.07-1.82). Regarding adverse fetal outcomes, maternal HS was significantly associated with spontaneous abortion (OR 1.19, 95% CI 1.06-1.34), preterm birth (OR 1.17, 95% CI 1.04-1.31), and birth defects (OR 1.47, 95% CI 1.03-2.11). Conclusions Pregnant women with HS have an increased risk of APOs, underscoring the need for coordinated care between dermatologists and obstetricians, as well as early diagnosis and intervention to mitigate potential risks to maternal health and fetal development.