Maternal and Fetal Outcomes Among Pregnant Women Developing Pemphigoid Gestationis

Pemphigoid gestationis (PG), a rare autoimmune condition characterized by pruritic urticarial plaques and blisters, typically develops in the second or third trimester of pregnancy. This study aimed to examine the associations between PG and adverse maternal and newborn outcomes.

Using the Healthcare Cost & Utilization Project-Nationwide Inpatient Sample from the United States, a retrospective cohort study was conducted consisting of pregnant patients admitted to the hospital for delivery between 2016 and 2021. The exposed group consisted of pregnant patients with PG (International Classification of Diseases, 10th Revision code O26.4), whereas the unexposed group consisted of pregnant patients without PG. The associations between PG and maternal and newborn outcomes were examined using multivariable logistic regression models adjusted for baseline maternal characteristics.

Of 4 337 612 births, 371 women developed PG, for an incidence of 8.6 per 100 000 deliveries. PG was more common among the following individuals: African-Americans, those belonging to lower income quartiles, having Medicare or Medicaid insurance, having thyroid disease, smokers, and morbidly obese. Furthermore, PG was associated with increased odds of gestational diabetes (OR 1.42; 95% CI 1.02-2.00), gestational hypertension (1.45; 1.01-2.08), preterm premature rupture of membranes (1.41; 1.02-1.95), caesarean delivery (1.65; 1.33-2.05), postpartum hemorrhage (1.78; 1.19-2.68), need for blood transfusion (2.38; 1.27-4.48), disseminated intravascular coagulation (9.78; 1.37-69.77), and sepsis (2.73; 1.22-6.14). No statistically significant adverse events were found for newborns of women developing PG in pregnancy.

PG in pregnancy is associated with adverse obstetrical outcomes. Our results provide population-based information to patients and health care providers on this rare and understudied condition.