You may be wondering whether a drug used to treat psoriais or psoriatic arthritis during pregnancy could increase the risk for birth defects. Keep in mind that in every pregnancy there is a 3-5 percent chance for some type of birth defect to occur regardless of any type of exposure. This is called the “background risk.” The safety of a drug during pregnancy is studied by comparing the rate of birth defects among babies whose mothers used the drug while they were pregnant to this background risk.
Which treatments are OK to use?
Many of the treatments used to treat psoriasis/psoriatic arthritis have not been adequately studied during pregnancy. And even if it has been studied, results are sometimes conflicting or difficult to interpret. When counseling a woman, the pregnancy risk specialists at MotherToBaby take into consideration both the quality and quantity of the research on a given medication.
There are several options depending on the severity of disease. Some treatments should be avoided during pregnancy, while others can be used safely. The National Psoriasis Foundation’s website provides a guide for the use of medications during pregnancy and breastfeeding. The use of over-the-counter topical moisturizers and emollients are the first choice of treatment. Topical steroids in low to moderate doses with limited use appear to be safe, but caution should be used during breastfeeding. The use of UVB phototherapy may be used as second choice of treatment.
Some systemic medications such as cyclosporine are used in combination with other medications and treatments. The effects on pregnancy are often complicated by the woman’s underlying illness or other aspects of treatment.
Which treatments are unsafe?
Avoid the use of oral retinoids and methotrexate because of a known increased risk for birth defects. These medications are called systemics, meaning they work throughout the body. They are prescribed for individuals with moderate to severe psoriasis/psoriatic arthritis, usually when other treatments aren’t effective or for individuals unable to take topical medications or UV light therapy. There are strict guidelines for prescribing systemics for women of childbearing age, including requiring two negative pregnancy tests before starting treatment.
Another class of prescription drugs called biologics generally should be avoided during pregnancy unless there is a clear medical need. These medications are derived from living cells cultured in a laboratory. They work by targeting specific parts of the immune system, thereby inhibiting inflammation and slowing disease progression. Two examples of biologics are Enbrel (etanercept) and Humira (adalimumab).
Talk to a healthcare provider who knows your medical history. Some medications should only be used if the benefits outweigh the risks.
How can we learn more about psoriasis/psoriatic arthritis treatments during pregnancy?
We have a lot to learn about psoriasis and psoriatic arthritis during pregnancy and the safety of the medications used to treat it. The information available on medications and treatments relies on pregnant women who are willing to share their experience in a confidential manner, so we recommend that all pregnant women participate in a pregnancy registry regardless of their medication use. Pregnancy registries are strictly observational, meaning you are not asked to change anything about your normal routine, including the medications you are taking.
Contact one or more of the below registries to learn more:
- Psoriasis/Psoriatic Arthritis Pregnancy Registry – studying all treatments: (877) 311-8972
- Acitretin Pregnancy Registry: (855) 850-2138
- Cimzia® Pregnancy Registry: (877) 311-8972
- Neoral® Pregnancy Registry: (888) 522-5581
- Otezla® Pregnancy Registry: (877) 311-8972
- Stelara® Pregnancy Registry: (877) 311-8972
Where can I get more information?
Hopefully, your healthcare providers can work together to find the best treatment during pregnancy. When in doubt, you can always call a MotherToBaby counselor. We’re here to answer your questions, and our service is FREE and confidential. Call us toll-free at (866) 626-6847.
In addition, MotherToBaby’s website has FREE fact sheets about some of the medications prescribed during pregnancy to treat psoriasis/psoriatic arthritis. Pregnancy risk specialists with expertise in the field of birth defects write these fact sheets based on evidence from well-designed research studies. We currently have fact sheets for adalimubab (Humira), certolizumab pegol (Cimzia), etanercept (Enbrel), and ustekinumab (Stelara).
Driving discovery, creating community
For more than 50 years, we’ve been driving efforts to cure psoriatic disease and improve the lives of those affected. But there’s still plenty to do! Learn how you can help our advocacy team shape the laws and policies that affect people with psoriasis and psoriatic arthritis – in your state and across the country. Help us raise funds to support research by joining Team NPF, where you can walk, run, cycle, play bingo or create your own fundraising event. If you or someone you love needs free, personalized support for living a healthier life with psoriatic disease, contact our Patient Navigation Center. And keep the National Psoriasis Foundation going strong by making a donation today. Together, we will find a cure.