Effects of pregnancy on chronic urticaria: Results of the PREG‐CU UCARE study
Emek Kocatürk, Mona Al‐Ahmad, Karoline Krause, Ana M. Giménez‐Arnau, Simon Francis Thomsen, Niall Conlon, Alexander Marsland, Ekin Şavk, Roberta Fachini Jardim Criado, I V Danilycheva, Daria Fomina, Kiran Godse, Maryam Khoshkhui, Aslı Gelincik, Ece Nur Değirmentepe, Semra Demir, Luís Felipe Ensina, Alicja Kasperska−Zając, Michael Rudenko, Solange Oliveira Rodrigues Valle, Iris Medina, Andrea Bauer, Zuotao Zhao, Petra Staubach, Laurence Bouillet, Özlem Su, Can Ateş, Marcus Maurer
Abstract
BACKGROUND: Chronic urticaria (CU) predominantly affects women, and sex hormones can modulate disease activity in female CU patients. As of now, the impact of pregnancy on CU is largely unknown. AIM: To analyze the course and features of CU during and after pregnancy. PATIENTS AND METHODS: PREG-CU is an international, multicenter study of the Urticaria Centers of Reference and Excellence (UCARE) network. Data were collected via a 47-item questionnaire completed by CU patients, who became pregnant within the last 3 years. RESULTS: A total of 288 pregnancies of 288 CU patients from 13 countries were analyzed (mean age at pregnancy: 32.1 ± 6.1 years, duration of CU: 84.9 ± 74.5 months; CSU 66.9%, CSU + CIndU 20.3%, CIndU 12.8%).During pregnancy, 51.1% of patients rated their CU as improved, 28.9% as worse, and 20.0% as unchanged.CU exacerbations most commonly occurred exclusively during the third trimester (in 34 of 124 patients; 27.6%) or the first (28 of 124; 22.8%). The risk factors for worsening of CU during pregnancy were having mild disease and no angioedema before pregnancy, not taking treatment before pregnancy, CIndU, CU worsening during a previous pregnancy, treatment during pregnancy, and stress as a driver of exacerbations. After giving birth, urticaria disease activity remained unchanged in 43.8% of CU patients, whereas 37.4% and 18.1% experienced worsening and improvement, respectively. CONCLUSIONS: These results demonstrate the complex impact of pregnancy on the course of CU and help to better counsel patients who want to become pregnant and to manage CU during pregnancy.