How psoriasis may affect pregnancy

Pregnancy is often a time filled with a lot of emotion. You may feel excitement, happiness, nervousness, fear, or worry. On top of the concerns like these, if you live with psoriasis or psoriatic arthritis, you may also have concerns about how these conditions will affect your pregnancy. Questions about medication safety for you and your baby, and how the changes to your body will influence disease activity, are important.

It’s also vital to understand the effects that pregnancy may have on psoriasis. A research review published in 2015 in Psoriasis reported that up to 56 percent of pregnant people experience improved psoriasis symptoms during pregnancy. Because of that improvement, people may switch to less-powerful treatments during pregnancy or discontinue use of medications.

It's also worth noting that, while many people experience improvement in their symptoms during pregnancy, nearly 27 percent of pregnant people in the review reported that symptoms worsened during pregnancy. Meanwhile, a small study published in 2018 in The Journal of Rheumatology showed that discontinuing biologic medications before pregnancy was associated with increased risk of flare-ups during pregnancy and postpartum.

In terms of baby’s health, several large studies suggest that psoriasis can lead to increased risk of low birth weight and pre-term birth, with the highest risk in those with severe disease. Psoriasis has also been associated with higher risk for ectopic pregnancy.

The important thing to remember is that both pregnancy and psoriasis are different experiences for each person. They key is to work closely with your healthcare providers (HCPs) to manage your pregnancy and your psoriasis in a way that makes the most sense for you.

Psoriasis treatment and pregnancy

It is important to discuss your psoriasis treatments with your HCPs, as many may not be safe during pregnancy. Here’s what to know.

Topical treatments

For pregnant people with mild psoriasis, experts, such as the American Academy of Dermatology Association, say topical treatments are the best options to try first. These include moisturizers and emollients, like petroleum jelly or mineral oil. Low- to moderate-dose topical steroids also appear to be safe during pregnancy. If you are breastfeeding, however, be careful about applying steroid creams to your breasts, so that you don’t pass the medication on to the baby.

Some topical medications should not used around pregnancy. For example, tazarotene may cause birth defects, and should not be used for at least 3 months before trying to conceive.

Phototherapy

Some types of light therapy—such as narrow-band UVB phototherapy, broad-band UVB, and even sunlight—are considered safe during pregnancy. This involves exposing the skin to ultraviolet light regularly and under medical supervision. Just be sure to apply sunscreen to your face before therapy to help prevent melasma, a condition in pregnant people that causes brown spots to appear. Another type of light therapy, called psoralen plus ultraviolet A (PUVA), is usually avoided.

Systemics

Systemic drugs impact the entire immune system and can pass through your bloodstream to your fetus. For that reason, HCPs typically stay away from systemic medications in pregnancy unless topical treatments and light therapy aren’t giving enough relief. A systemic drug called cyclosporine has been linked to premature delivery and low birth weight. Oral retinoids and methotrexate are known to cause birth defects and generally should not be used.

When a couple is trying to become pregnant, it is important to note that both partners should avoid methotrexate use. People who have periods should wait one menstrual cycle and others should wait for at least three months after the last dose before trying to conceive. The oral retinoid acitretin should be stopped for at least three years before trying to conceive.

Biologics

Biologics are given as an injection and may increase risk of infection. Biologics can impair the a newborn’s immune system, so some HCPs recommend stopping them either before or at some point during pregnancy and delaying the newborn’s first vaccines if the biologics continue to be taken throughout pregnancy. Generally, HCPs aim to use other methods to manage psoriasis and only use systemics or biologics in severe cases.

It’s important that you speak with your HCP before going on or off any medications. By following precautionary measures and advice from your care team, you can help put your psoriasis and pregnancy worries at ease.