As with many chronic inflammatory disorders, psoriasis presents certain challenges and considerations surrounding childbirth. Taking proper precautions and applying treatments (if necessary) as directed by your doctor(s) will help ensure that you experience an uncomplicated and uneventful pregnancy with psoriasis.
However, it is also helpful to be aware of some of the more significant possible complications, so that you can stay alert and be proactive about any signs, symptoms or other changes occurring during this period. Interestingly, being pregnant tends not to affect disease course, and in some cases, pregnancy itself has been shown to be beneficial with regard to psoriasis flares, probably as a result of hormonal changes, though this finding is not universal.
What are some pregnancy complications that could result from my psoriasis condition?
While there are a few events that occur more often in pregnant psoriasis patients, the majority of potential complications involve the treatment of the disease, rather than the disease itself. There is an excellent review of all the various treatments for psoriasis, including indications for pregnancy precautions, available from the Mayo Clinic.
Of the complications not related to therapies, the most common are miscarriage, hypertension and premature rupture of membranes (PROM), in addition to higher incidence of C-section. Also, several co-existing conditions have been identified, including obesity, smoking history, depression and lack of prenatal vitamins, which can increase the risk for the complications listed above. Occasionally, for those with severe psoriatic arthritis, problems may arise with ambulation and performing normal physical activities, because of pain and immobility. Secondary infections, as a result of breaks in the skin, are a common concern with psoriasis normally, so major infections can negatively impact pregnancy. It is prudent to keep a particular eye on this during the entire pregnancy.
As mentioned above, by far the biggest consideration in women who are pregnant or trying to get pregnant, is expert management of therapy, which should be the result of a discussion between your dermatologist and obstetrician, so they can tailor treatments for your specific clinical situation.
There are certain medications labeled pregnancy category “X” that are absolutely banned, such as methotrexate and Acitretin, among others. If you take any of these you will need to stop them before trying to become pregnant, and should discuss this with your doctor. But other meds lie in more of a gray zone, and different physicians have different comfort levels prescribing them during pregnancy. For instance, even though it’s unlikely that substantial systemic absorption (into the blood stream) would occur, certain topical treatments (such as topical steroids and retinoids) may need to be stopped or adjusted, as per your doctor(s).
What are the treatments, and what is the risk of complications for the fetus/baby?
Thankfully, modern medicine has made potential complications in pregnancy much less of an issue than it once was. However, there are certain conditions that do require some form of intervention. As indicated in the previous question, women most commonly need to adjust or stop certain medications during pregnancy; so the “treatment” in this case is stopping certain treatments. Other treatments will depend on the individual circumstance, but since infections tend to exacerbate psoriasis flares, it is important to be mindful of possible infections and get treatment quickly if needed. Using flares as an indicator for increased alertness, you may be able to stave off any infections and related discomfort by receiving prompt treatment.
In terms of risk to the baby, as long as medication recommendations are followed, along with a strict prenatal regimen, there is generally no cause for serious concern. Still, if problems arise during pregnancy, whether related to psoriasis or not, your physician should be notified. As with all pregnancies, a very important factor is living healthy (good diet, no smoking) during this period, and taking prenatal vitamins regularly. Doing so will afford you and your baby the best chance for an uncomplicated pregnancy and delivery.
If psoriasis begins while I’m pregnant, am I at risk for these complications as well?
The short answer is yes, because it really doesn’t matter when the disease starts with regard to possible effects on the pregnancy. However, since many of the major complications can be the result of medication mismanagement, the chance of this occurring without a diagnosis of psoriasis is extremely low.
The real issue when psoriasis is suspected during pregnancy is ruling out other possible causes of signs and symptoms from an initial list of possible diagnoses. Especially in pregnancy, it is crucial to establish a definitive diagnosis before considering any therapies. And remember, since psoriasis has been putatively linked to infection, a sudden outbreak during pregnancy may be a sign that an infection is present somewhere, possibly requiring treatment. Luckily, with a few exceptions, most infections make their hosts keenly aware of their presence, without requiring psoriasis exacerbations for discovery.
Questions for your doctor:
- Are there any specific (to psoriasis) regimens of medications and/or foods/supplements I should be taking or following during my pregnancy?
- What activities or exposures, if any, should I avoid during pregnancy?
- Should I treat flares during pregnancy (or when trying to get pregnant) normally, or are changes required in type/dosage of topical or systemic meds?
- Which potential complications should I be most concerned with and watching for during my pregnancy?
- Are there any other serious concerns or potential complications besides those listed in this article?
About the Author
Dr. Rothbard is a professional medical writer and consultant based in New York City, specializing in medical education articles targeted at a variety of audiences, from children through clinicians. After leaving medicine, he worked as a biology and medical science educator for several years, before deciding to pursue writing full-time. He may be reached at [email protected].