Hidradenitis Suppurativa Linked to Higher Cesarean and LGA Odds

Pregnancy outcomes in patients with hidradenitis suppurativa (HS) have largely been characterized through claims databases, which suggest increased risks for several adverse maternal and neonatal outcomes. A retrospective case-control study published in the Journal of the American  Academy of Dermatology adds a more granular view from an urban safety-net population, finding that HS was associated with higher odds of cesarean delivery and having a large-for-gestational-age (LGA) neonate, even after adjustment for relevant confounders.

A Matched Cohort Links Maternal and Neonatal Records
Investigators identified 232 patients with HS who had at least 1 pregnancy between 2011 and 2021 and matched them 1:3 by age, race/ethnicity, and body mass index to 464 controls. The analysis encompassed 338 pregnancies among patients with HS and 676 among controls, with maternal and neonatal medical records linked to evaluate outcomes.

The cohort reflected the safety-net setting: approximately 78% of participants were Black or African American, and 69% had Medicaid insurance. Mean age at pregnancy was 29 years, and mean prepregnancy body mass index was 30 kg/m². Most patients with HS, 68.5%, had Hurley stage 1 disease. Baseline comorbidities were generally similar between groups.

Cesarean Delivery and Fetal Size Emerge as Key Differences
Among deliveries, 43.75% of patients with HS underwent cesarean section compared with 34.05% of matched controls. After adjustment for LGA and pregnancy complications, HS remained associated with approximately 80% higher odds of cesarean delivery (adjusted odds ratio [aOR], 1.81; 95% CI, 1.09-3.01; P=.023). Genital HS did not increase the odds of cesarean delivery within the HS group, suggesting that anatomic involvement alone did not account for the association.

A second signal emerged in neonatal size. LGA neonates occurred in 19.21% of HS deliveries compared with 12.59% of control deliveries. After adjustment for gestational diabetes and race/ethnicity, patients with HS had more than twice the odds of an LGA neonate (aOR, 2.12; 95% CI, 1.05-4.26; P=.035). The authors note that this finding may have implications for prenatal and postnatal monitoring, although confirmation in larger populations is needed.

Not all outcomes pointed toward greater obstetric risk. Patients with HS had lower adjusted odds of elective termination (aOR, 0.61; 95% CI, 0.44-0.83) and ectopic or molar pregnancy (aOR, 0.41; 95% CI, 0.19-0.90). Preterm labor was also less frequent, occurring in 36.72% of HS deliveries versus 52.33% of controls. The association persisted after adjustment for hypertension, diabetes, smoking, alcohol, and other substance use (aOR, 0.60; 95% CI, 0.37-0.96).

A More Nuanced Picture of Pregnancy Risk In HS

These findings differ in several respects from previous claims-based studies, which have reported inconsistent but generally higher rates of adverse pregnancy outcomes among patients with HS. The authors suggest several possible explanations, including differences in study populations and methodology. More frequent contact with a high-risk obstetrics clinic among patients with HS may also have contributed to some favorable outcomes.

Interpretation requires caution. The retrospective, single-center design introduces the potential for miscoding and incomplete records when care occurred outside the institution. The analysis also lacked information on previous pregnancy complications, and the predominantly mild HS population limits conclusions about more severe disease. Subgroup analyses suggested that patients with Hurley stage 2 or 3 disease had higher odds of preterm labor and lower odds of LGA than those with stage 1 disease, but statistical power was limited.

For clinicians caring for pregnant patients with HS, the study sharpens attention on 2 outcomes rather than suggesting uniformly elevated obstetric risk. The associations with cesarean delivery and LGA persisted after adjustment, while several other outcomes did not follow patterns reported in larger database studies. Larger studies incorporating HS severity, disease duration, treatment, and previous obstetric history will be important for determining which patients warrant additional monitoring and how HS-specific factors contribute to pregnancy outcomes.

Reference:
Pilitsi E, Zangenah N, Shen LY, Lam CS. Higher odds of c-section and large for gestational age neonates in patients with hidradenitis suppurativa at a safety-net urban academic hospital: a retrospective case control study. J Am Acad Dermatol. 2026;95(3):820-823. doi:10.1016/j.jaad.2026.05.017