Do people with psoriasis have a harder time getting pregnant? Which psoriasis treatments are safe for both the mother and baby during pregnancy? A recent episode of “Psound Bytes” — a podcast about psoriasis from the National Psoriasis Foundation — dove into these questions and others.
The episode, “Family Planning and Psoriasis,” featured Dr. Jenny Murase, an expert on women’s health and psoriasis. Dr. Murase is an associate clinical professor of dermatology at the University of California, San Francisco and the director of medical consultative dermatology at the Palo Alto Medical Foundation in Mountain View, California.
In the podcast, Dr. Murase answered several questions about how psoriasis, PsA, and their treatments impacted fertility, pregnancy, and breastfeeding.
Many people living with psoriasis worry about how the condition and treatments may affect fertility, their ability to have biological children. However, Dr. Murase said that psoriasis usually does not make it more difficult for a couple to conceive.
“There is a bit of evidence that having psoriasis in the genital area in men can slightly reduce fertility,” said Dr. Murase. “But for our female patients, psoriasis — even severe cases — does not affect their fertility.”
A person may find their psoriasis improves during their pregnancy, thanks to a surge in the hormone estrogen. “The most common hormonal change that we hear about is that psoriasis tends to improve during pregnancy, and the improvement is quite dramatic: 80 percent of [a person’s lesions] will disappear,” said Dr. Murase.
Dr. Murase said that psoriasis gets better for about half of people during pregnancy. However, she also noted, “It can worsen about a quarter of the time — so about 25 percent. But the worsening is usually quite mild.”
If someone’s symptoms go away during pregnancy, they typically return after they’ve given birth. “After the child is born, there is a flare of psoriasis when the estrogen level drops,” Dr. Murase said. “About two-thirds of patients will flare.”
Additionally, psoriasis flares can also affect the skin of the nipple during breastfeeding. “It’s very important that the mother is informed that they need to have a lactation consultant that they could speak with, and also make sure that the nipple skin is in as good of shape as possible prior to the delivery,” advised Dr. Murase.
Some people have extra problems or complications while they are pregnant that could put their health or their baby’s health at risk. However, it’s not entirely clear whether psoriasis can increase a person’s chance of experiencing these complications — some studies have found an elevated risk, while others haven’t. “We really don’t have a clear answer,” Dr. Murase said.
Dr. Murase mentioned that light therapy is a safe treatment during pregnancy. However, she noted that this treatment could cause folic acid levels to drop, which can lead to birth defects. She recommended that every woman of childbearing age using light therapy take 1 milligram or more of folic acid every day, just in case they become pregnant.
When it comes to oral and injectable medications, Dr. Murase noted that Cimzia (certolizumab pegol) is known to be safe for pregnancy, because the drug doesn’t cross the placenta and reach the baby. Studies also show that other tumor necrosis factor-alpha (TNF-alpha) biologics are safe.
Topical corticosteroids are safe to use during pregnancy, but it is important to know that this treatment can lead to permanent, sometimes severe, stretch marks as a side effect.
The list of treatments that can be used during pregnancy is similar to the ones used during breastfeeding. “The vast majority of therapies that a woman would take while they’re pregnant is going to be safe to breastfeed,” said Dr. Murase. “This includes the biologic therapies.”
Dr. Murase advocated for early conversations about pregnancy between people with psoriasis and their health care providers. If a person with this condition wants to get pregnant in the future, it may affect their treatment options.
“It’s important to have that discussion because it really does affect what therapy we’re going to recommend and if we would move to a different therapy, perhaps a few years down the line, based on their plans,” she said.