Effect of study bias, publication bias, and small-study effects In all analyses, the pooled estimated SMDs for the subgroups of studies deemed to have low bias was within the 95% CI of the overall (Table 4), suggesting the impact of studies with higher bias was small

How pregnancy affects APD symptoms Some women experience worsening skin or allergic symptoms , particularly early in pregnancy Others report symptom improvement or complete remission , possibly due to gradual progesterone increases and immune tolerance In some cases, APD may first appear during pregnancy or after childbirth , potentially due to immune sensitization during gestation Management during pregnancy Antihistamines are often used to control histamine-mediated symptoms and are commonly part of pregnancy-safe treatment plans Progesterone desensitization may be considered before conception or early in pregnancy for those with severe reactions Close monitoring allows clinicians to balance symptom control with fetal safety Postpartum considerations Symptoms may recur or worsen after delivery , when progesterone levels drop rapidly Ongoing follow-up is important to manage postpartum flares and guide future family planning With individualized care and proactive planning, many people with autoimmune progesterone dermatitis are able to conceive, maintain pregnancy, and deliver safely

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