Outcomes of pregnancies among women and partners of men with a history of exposure to methoxsalen photochemotherapy (PUVA) for the treatment of psoriasis.
Because oral methoxsalen and UV-A radiation (PUVA) therapy is mutagenic, concern exists about the potential for teratogenic effects resulting from the use of this therapy at the time of conception and during pregnancy. After 12.8 years of prospective study, we documented the pregnancy outcomes among 1380 patients (892 men and 488 women) who received PUVA treatments. Ninety-four men reported 167 pregnancies in their partners, and 93 women reported 159 pregnancies. For 34% of pregnancies among partners of male patients, the man received PUVA therapy near the time of conception. Nineteen percent of female patients reported exposure to PUVA at the time of conception or during pregnancy. Induced and spontaneous abortions were reported as the outcome of pregnancy more often by female than by male patients (12% vs 30%). Two congenital malformations and two stillbirths occurred, an incidence not significantly different from that expected for the general population. Although the power of our study to detect an increase in the risk of specific defects is limited, our data show no evidence to suggest that PUVA is a potent teratogen. Still, because PUVA is mutagenic, we believe it prudent for patients to avoid PUVA treatment during pregnancy whenever practical.
Stern
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RS
Department of Dermatology, Beth Israel Hospital, Boston, MA 02215.
Lange
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R
D000028:Abortion, Induced / Q000706:statistics & numerical data*; D000328:Adult; D015331:Cohort Studies; D004341:Drug Evaluation; D005260:Female; D005313:Fetal Death / Q000209:etiology; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008730:Methoxsalen / Q000009:adverse effects*; D008875:Middle Aged; D011701:PUVA Therapy / Q000009:adverse effects*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy*; D011446:Prospective Studies; D011565:Psoriasis / Q000188:drug therapy*; D014427:Twins
D008730:Methoxsalen