Pregnancy is supposed to be a time of happiness, anticipation, and planning. But for women living with psoriasis and their partners, there are additional worries, including if you will pass psoriasis on to your child, anticipating flares, planning for treatments, and worrying about how safe treatments will be before and during pregnancy and if you can breastfeed your new baby.
Here is what you need to know about genetic risk, planning for pregnancy, managing pregnancy, delivery, and life after the birth of your baby while living with psoriasis.
Understanding Genetic Risk
Researchers believe psoriasis is a genetic condition, but they don’t completely understand what causes the disease to be passed down from one generation to another. An inheritance pattern for psoriasis may involve multiple genes or a combination of genes.
A 2012 report in Nature Genetics expands on several genome (genetic) association studies comparing DNA from people with psoriasis to people without it to determine genetic variations associated with the disease. Researchers looked at collected DNA and other information and determined the number of genes involved in psoriasis are 36. Not all of these genes account for psoriasis risk and development, but they do give an idea of the risk of passing psoriasis-associated genes.
Most people who have psoriasis report they have a relative who has psoriasis. And having a parent with psoriasis increases a person’s risk for developing the condition. A parent with the disease has a 10% chance of passing the disease on to their child and if two parents have the condition, there is a 50% chance of passing the disease on to a child.
The strongest evidence on genes involved in psoriasis comes from twin studies. One 2013 review of studies of twins and psoriasis reported in the Journal of Investigative Dermatology shows an up to 75% gene agreement in risk for identical twins, compared to an about up to 30% for non-identical twins. But having identical genes is not the only risk factor. There are also environmental factors and triggers at play. After all, researchers have long believed that psoriasis is triggered by a combination of genes and external forces.
Another twin study reported in the same review shows when twins are affected by psoriasis, there tends to be “similar age of onset, disease distribution, severity, and clinical course.” The report further notes a strong genetic association to certain races, even though this is a smaller part of a bigger picture that includes other risk factors shared by families, i.e. exposure to aspects of the same environment.
Genetic risk is not enough for a person to develop psoriasis. Other environmental factors—such as infection, use of certain medications, or the presence of other health conditions, smoking, and stress—need to trigger the condition. This means that passing certain genes to your child does not mean your child will develop psoriasis.
Planning for Pregnancy
There isn’t any evidence that shows psoriasis affects getting pregnant. However, there is a potential for adverse events. One study reported by the Journal of the American Academy of Dermatology found women with severe psoriasis were more likely to have babies born at low birth weight than women who did not have the condition. The study authors noted that women with mild psoriasis did not have this same risk. To reduce risk to your baby, you should attempt to get psoriasis under control before pregnancy so you can avoid flare-ups and having to take potent medications during pregnancy.
If you tell your psoriasis-treating healthcare provider that you are considering getting pregnant, he or she may recommend you avoid psoriasis treatments or only use the safest ones. Each psoriasis medication has its own safety concerns, but in general, certain topical therapies tend to be safe for use by women trying to conceive, who are pregnant, or breastfeeding. Your practitioner is in the best position to determine what treatments are safest for you to use.
A planned pregnancy can help you and your practitioner plan for minimal treatment before getting pregnant and during pregnancy. You and your healthcare provider can work out a treatment plan in advance of your becoming pregnant. Men should also limit their psoriasis treatments as well. In general, any type of systemic (whole body) treatment could be stopped, such as methotrexate, which is known for increasing risk for miscarriage and birth defects. In fact, methotrexate should be discontinued before trying to conceive.
The bottom line is that if you are taking any drug by mouth, it is a good idea to avoid this drug while trying to conceive. If you get pregnant using methotrexate, a biologic, or other oral medication, let your healthcare provider know right away.
Hormonal and immune changes may induce or reduce psoriasis symptoms. Most of the research suggests for the majority of women pregnancy tends to improve psoriasis symptoms or doesn’t change them at all. Of course, this varies from person to person.
Pustular Psoriasis of Pregnancy
During pregnancy, women with a personal or family history of psoriasis have a higher risk for pustular psoriasis of pregnancy (PPP). While rare, a woman with no family or personal history can also develop this condition. Women who develop PPP do so during their third trimester of pregnancy.
PPP is a life-threatening condition—both for mother and baby—and must not be ignored. A woman with this condition will have areas of inflamed skin with pustules. Pustules are pimple-looking bumps full of a yellowish fluid called pus. Affected skin areas are usually anywhere where skin folds, such under the breasts or armpits or the groin. Pustules usually do not affect the face, hands or soles of feet. Pustules can also join together and form large plaques.
Additional symptoms of PPP are fatigue, fever, diarrhea, and delirium (severe and sudden confusion). Women who experience symptoms of PPP should seek immediate medical treatment, as the condition can be dangerous to both mother and baby. Fortunately, PPP is treatable.
Psoriasis is known for occurring alongside other autoimmune and inflammatory diseases and depression which may or may not affect a women’s pregnancy. Diabetes, high blood pressure, and other metabolic conditions may be present and pose the potential for adverse events during pregnancy. Overall, there is no conclusive evidence that suggests psoriasis on its own increases the risk for any adverse outcome.
Some of your regular treatments for psoriasis may not be suitable for you to take during pregnancy. Your treatment options are dependent on the type of psoriasis you have, how severe it is, your personal preferences, and your practitioner’s recommendations. Work with your healthcare provider to determine a suitable treatment plan for managing psoriasis during pregnancy.
Many topical applications, including creams and ointments, might be safe for use by pregnant women, especially when used in small areas on the body. According to a 2016 report in JAMA Dermatology, topical corticosteroid use of any strength plays no part “with mode of delivery, birth defects, preterm delivery, fetal death, and low Apgar score.” They did note overuse could contribute to low birth weight.
Another study reported in 2015 by the Cochrane Database of Systemic Reviews concluded topical steroids of mild to moderate strength are unlikely to negatively affect pregnancy. However, the National Psoriasis Foundation does not recommend any type of steroid cream for use during pregnancy, and only recommends over the counter topicals, such as petroleum jelly or mineral oil, for use during pregnancy.
Much of the research on biologic medication use is newer and it is uncertain what biologics are the safest for use before and during pregnancy. One study reported in 2018 by the Annals of the Rheumatic Diseases suggests treatment with biologics during pregnancy does not increase the risk for preterm birth or low birth weight. Because there are few studies with similar findings, the researchers merely suggest biologics might be a safe option. Ultimately, the decision whether continue biologic treatment is one you and your partner should discuss with your healthcare provider before trying to become pregnant.
Some types of light therapy, also called phototherapy, are safe for use during pregnancy. Light therapy consists of exposure to daylight or specific wavelengths of light.
Any type of light therapy that uses ultraviolet light is not suitable for use during pregnancy.
For women with psoriasis, a healthy delivery is possible. Labor may increase the chance for a psoriasis flare. A cesarean delivery is a skin trauma and may induce a serious flare, as may hormonal changes. One 2015 report in Psoriasis: Targets and Therapy reported on an older study about postpartum flares finding that post-delivery psoriasis flares were observed in 87.7% of patients within four months of delivery.
Breastfeeding with psoriasis is very possible, as the condition is not contagious. However, you should check with your healthcare provider about what medications are safe while breastfeeding, as some may get into breast milk. Researchers haven’t studied the effects of psoriasis treatments on breastfed infants. If your practitioner thinks you need treatments while breastfeeding, you should discuss alternative methods for feeding your baby. In some cases, you may be able to schedule medications until after you have breastfed your baby.
Most non-medicated topical treatments are OK for use while nursing your baby. You should still check with your healthcare provider about which ones are safest.
Avoid applying a topical medication to nipples and wash breasts before breastfeeding your baby.
According to the Academy of Dermatology, there are two types of phototherapy— narrow-band UVB and broadband UVB—that are safe for use while breastfeeding. There has been no clinical evidence suggesting phototherapy can harm a baby through breast milk.
A Word From Get Meds Info
Psoriasis doesn’t stop you from getting pregnant, having a healthy pregnancy, and delivering a healthy baby. Pregnancy may even give you a nine-month reprieve from itchy, scaly skin plaques. Even if your psoriasis doesn’t subside, there are still safe treatments you can take while pregnant.
And don’t worry that your will baby might have psoriasis later down the road. Talk to your child’s pediatrician after your baby is born about your medical history and stay on top of routine wellness visits so your child can be checked early on for signs and symptoms of psoriasis.
Of course, nothing is certain and the information on genetics is based on risk statistics. If someone with risk factors goes on to develop psoriasis, it comes down to environmental triggers in addition to genetics. Plenty of women with autoimmune diseases, like psoriasis, have healthy babies who grow up and don’t ever develop psoriasis or another autoimmune disease.