If you have psoriatic arthritis (PsA) and want to grow your family, you may wonder if it’s safe to become pregnant. “I’m thinking of getting pregnant. I have psoriatic arthritis and was wondering what anyone can tell me about pregnancy with this?” one MyPsoriasisTeam member asked. If you have PsA and are considering pregnancy, talk to your rheumatologist and your obstetrics provider. Your doctor can help you create a plan that will help you manage your condition and have a healthy pregnancy.

Pregnancy and Psoriatic Arthritis Treatment

Managing your PsA and medications can be difficult while you’re pregnant or trying to conceive. One member posted, “It is just a tricky situation since I am trying to get pregnant. I’m not allowed to use all of the biologics right now.”

Your doctor will discuss with you which medications can be continued during pregnancy and which are unsafe. If the drugs you’re taking are currently controlling your symptoms and will not harm the baby, your doctor will probably not change them. Over-the-counter topicals, medications applied directly to the skin, are generally safe for mild psoriasis, but you should still inform your doctor if you’re using them.

Methotrexate

Methotrexate is an oral medication that can be used to treat mild to severe psoriasis. It’s not recommended for use during pregnancy because it can cause miscarriages or harm to the fetus. Your doctor will recommend you stop treatment at least 12 weeks before trying to become pregnant. Once the medication is stopped, there’s little to no risk to the fetus, and there are no negative effects on the long-term potential to become pregnant.

Biologics

Biologics are a common treatment option for people with PsA. Over recent years, more research has shown that biologic treatment is generally safe during pregnancy for you and your child. Talk with your rheumatologist and your obstetrics provider about the risks and benefits of each biologic medication.

Biologics that treat PsA are mainly antibodies, similar to those made by the body’s immune system. Only one specific type of antibody, known as immuglobulin G (IgG), can cross the placenta and travel from mother to fetus.

Anti-tumor necrosis factor-alpha biologics are the most researched biologics for use in pregnancy. They’re generally considered safe to use early in pregnancy because of low antibody levels in the fetus.

Some biologics contain IgG antibodies, which can pass to the fetus. Others are similar in structure to the IgG antibody but are different enough that they don’t cross the placenta as much. Ask your doctor if you can continue to use your biologic throughout pregnancy. Studies have also shown that many biologics can be continued during breastfeeding.

JAK Inhibitors

Janus kinase (JAK) inhibitors are a newer type of oral medication. Examples include tofacitinib (Xeljanz), baricitinib (Olumiant), and upadacitinib (Rinvoq). JAK inhibitors are generally not recommended during pregnancy. These drugs, used for a variety of conditions including PsA and inflammatory bowel disease, have been shown to cause birth defects in animal studies. Because these studies are relatively new, there is limited data on adverse pregnancy outcomes in humans.

If you’re taking a JAK inhibitor and are thinking about pregnancy, speak to your doctor about changing your treatment plan.

Retinoids

Retinoids are compounds derived from vitamin A, which can be used to treat skin conditions like psoriasis. However, these medications have a high risk of causing birth defects and should be stopped before trying to conceive. Examples of retinoids include isotretinoin and acitretin.

Topical Treatments

Topical treatments are beneficial for skin psoriasis, and some can also be used during pregnancy. Emollients are creams or lotions that moisturize the skin, making it feel smoother. They’re often used because they usually don’t cause side effects. Steroid creams, which help reduce skin inflammation, can also be used but should be applied in low to medium amounts. It’s important to use stronger steroid creams carefully and not too often. If you’re using creams on your breasts, be careful, as these can be passed to a baby during breastfeeding.

Managing Psoriatic Arthritis During Pregnancy

Your PsA symptoms might change during pregnancy. Be sure to talk to your rheumatologist about any positive or negative changes in your condition.

Most people do not experience worsening symptoms or higher disease activity during or after their pregnancies. One MyPsoriasisTeam member posted, “Mine went away completely while I was pregnant!” But a second said, “Mine was the opposite. I have been pregnant four times, and every time, my skin flared up a lot.” Another member commented, “When I was pregnant, my psoriasis disappeared, and I had no problems with my arthritis. So, it’s different for everyone. Talk to your doctor about it, go for it, and see what happens. Good luck.”

There’s an increased risk for changes to your disease during pregnancy and after delivery because of medication and hormonal changes. One member stated, “My psoriasis went [away] completely when I was pregnant but came back very quickly after.” This may be caused by fatigue or other postpartum symptoms. You and your doctor should closely monitor your symptoms.

If you experience back or joint pain as a PsA symptom, pregnancy may increase this pain as the baby grows and adds weight to these areas. General aches and pains from PsA are often increased during pregnancy. This pain also leads to higher levels of fatigue and tiredness. As always, discuss your symptoms with your rheumatologist and your obstetrician.

Delivery

PsA usually does not affect the ability to have a vaginal birth. This is only complicated if arthritic pain worsens in the hip or pelvis region. Also, inflammatory arthritis could complicate a vaginal delivery or make giving an epidural difficult.

During childbirth, especially with a cesarean section, the skin can be injured, which might take time to heal. This is particularly important for people with psoriasis because they may experience the Koebner phenomenon. This condition causes new psoriasis patches to appear on areas of the skin that have been traumatized or injured. If you have psoriasis, discuss this possibility with your health care providers to manage the condition effectively during and after delivery.

Postpartum

As cited in the journal Seminars and Arthritis and Rheumatism, arthritis and psoriasis disease activity worsens at higher rates after birth compared to during pregnancy. Pregnant women reported more severe arthritis symptoms 33 percent to 50 percent of the time after delivery. These symptoms were reported only 15 percent to 22 percent of the time during pregnancy. A similar trend was noted with psoriasis treatment. Of the mothers surveyed, 27 percent to 34 percent reported more severe symptoms after birth, and less than 6 percent felt that their symptoms were worse during pregnancy.

Be sure to talk to your doctor about your breastfeeding plans before, during, and after pregnancy. If you choose to breastfeed, your doctor may change their recommendations around your medications. Keep your child’s pediatrician in the loop as well. Disease flare-ups are possible up to six months after delivery. Take time to care for yourself.

Talk With Others Who Understand

MyPsoriasisTeam is the social network for people with psoriasis. On MyPsoriasisTeam, more than 130,000 members come together to ask questions, give advice, and share their stories with others who understand life with psoriasis.

Are you living with psoriasis? Do you have experience with arthritis and pregnancy? Share your story in the comments below, or start a conversation by posting on your Activities page.