By Patricia Olney, MS, CGC, Genetic Counselor & Teratogen Information Specialist, MotherToBaby Georgia

If you’re pregnant and living with psoriasis/psoriatic arthritis, you may be wondering whether a medication used during pregnancy to treat psoriasis/psoriatic arthritis could increase the risk for birth defects over and above the 3-5% background risk.

What psoriasis/psoriatic arthritis drugs should a pregnant woman absolutely avoid?

Many of the medications 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 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.

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.

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.

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. The National Psoriasis Foundation’s website (www.psoriasis.org) provides a guide for the use of medications during pregnancy and breastfeeding. And 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 (www.mothertobaby.org) 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®).

Stay tuned for my next blog, which will focus on medications and breastfeeding, and managing psoriasis/psoriatic arthritis with a newborn.

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Online resources for individuals with psoriasis/psoriatic arthritis:

National Psoriasis Foundation (http://www.psoriasis.org)

TalkPsoriasis Support Community (http://www.inspire.com/groups/talk-psoriasis/)

Talk Health Partnership (http://www.talkhealthpartnership.com/talkpsoriasis/)

Patricia Olney is a certified genetic counselor and pregnancy risk specialist at MotherToBaby Georgia at Emory University. She received her masters degree at the University of California, Berkeley and has practiced genetic counseling for more than 25 years.

MotherToBaby is a service of the Organization of Teratology Information Specialists (OTIS), a suggested resource by many agencies including the Centers for Disease Control and Prevention (CDC). If you have questions about medications, vaccines, diseases, or other exposures, call MotherToBaby toll-FREE at 866-626-6847 or call the Pregnancy Studies team directly at 877-311-8972. You can also visit MotherToBaby.org to browse a library of fact sheets and to find your nearest affiliate.se the risk for birth defects over and above the 3-5% background risk.

What psoriasis/psoriatic arthritis drugs should a pregnant woman absolutely avoid?