Pregnancy & Psoriatic Arthritis

Pregnancy and Psoriatic Arthritis

What is psoriasis and psoriatic arthritis?

Psoriasis is a skin condition in which skin cells grow faster than usual. This can lead to dry, thick patches on the skin. Psoriasis is not contagious, so you cannot catch it from another person. While the exact causes are not known, the immune system is thought to be involved. In addition to changes to the skin, some persons with psoriasis will also develop swollen and painful joints, called psoriatic arthritis (PsA). Symptoms of psoriasis and PsA can range from mild to severe.

I have psoriasis and /or psoriatic arthritis. Can it make it harder for me to get pregnant?

These conditions might affect fertility, although not all studies agree. One study did not find an increase in time to become pregnant among people with mild to moderate psoriasis. However, another study of persons with moderate to severe psoriasis has suggested that ovarian reserve (the number of eggs stored in the ovaries) might be affected by psoriasis. The people with psoriasis in this study were still able to become pregnant. Effects on fertility might depend on whether symptoms are currently mild or severe, or if there are additional health conditions for the person who is pregnant.

Does having psoriasis and/or psoriatic arthritis increase the chance for miscarriage?

Miscarriage is common and can occur in any pregnancy for many different reasons. Based on the studies reviewed, it is not known if psoriasis or PsA increases the chance for miscarriage. One study that looked at 298 pregnancies in persons with moderate to severe psoriasis found that the rates of miscarriage did not differ from rates in the general population. Another study found a higher rate of miscarriage after the diagnosis of PsA in 37 pregnancies compared to their pregnancies prior to the diagnosis. However, age at time of pregnancy was higher after the diagnosis of PsA, and as people age, so does the chance for miscarriage. This, plus the small number of pregnancies looked at, does not allow for conclusions regarding miscarriage and PsA.

Does having psoriasis and/or psoriatic arthritis increase the chance of birth defects?

Every pregnancy starts with a 3-5% chance of having a birth defect. This is called the background risk. Studies have not been done to see if psoriasis or PsA increases the chance for birth defects.

Would having psoriasis and/or PsA increase the chance of other pregnancy related problems?

This isn’t clear because some studies have reported a higher chance for pregnancy related problems, but other studies have not.
One study found that people with severe psoriasis were more likely to have a baby with low birth weight (weighing less than 5 pounds, 8 ounces [2500 grams] at birth), while another study among people with moderate to severe psoriasis found the opposite, that they were more likely to have a baby with a heavier birth weight. Some studies have suggested that psoriasis or PsA increases the chance for preterm delivery (birth before week 37) or pre-eclampsia. Preeclampsia is a serious pregnancy related condition that can cause symptoms such as high blood pressure or fluid retention. Other studies have not reported an increased chance for these pregnancy complications. The chance for pregnancy complications might depend on whether the psoriasis and/or PsA symptoms are currently mild or severe. The chance for pregnancy complications can also be affected by the overall health of the person who is pregnant. For example, a study found a higher rate of smoking, depression, and obesity with persons with psoriasis.

Does having psoriasis and/or psoriatic arthritis in pregnancy affect future behavior or learning for the child?  

Studies have not been done to see if psoriasis or PsA can cause behavior or learning issues for the child.

I am taking medication for psoriasis and/or psoriatic arthritis. Can I take my medication during pregnancy?

It is important that you discuss treatment options with your healthcare providers when planning pregnancy, and as soon as you learn that you are pregnant.

How will pregnancy affect my psoriasis and/or PsA symptoms?

Healthcare providers are not able to predict how a person’s symptoms might change, if at all, during pregnancy. People who are pregnant have reported symptoms that improved, stayed the same, or became worse during pregnancy. In general, it appears that more people report that their disease symptoms improve or stay the same rather than get worse during pregnancy. However, a flare up of symptoms after delivery is common.

Breastfeeding while I have psoriasis and/or psoriatic arthritis?

There are no cautions regarding breastfeeding specific to psoriasis or PsA. Be sure to talk to your healthcare provider about your breastfeeding questions.

If a male has psoriasis and /or psoriatic arthritis, can it make it harder to get a partner pregnant or increase the chance of birth defects?

Autoimmune diseases like psoriasis might affect a man’s fertility. Certain medications used to treat psoriasis or PsA could also affect a man’s sperm production. This could make it harder to get a partner pregnant. In general, exposures that fathers or sperm donors have are unlikely to increase risks to a pregnancy.

References:

  • Bandoli G, et al. 2010 Potentially modifiable risk factors for adverse pregnancy outcomes in women with psoriasis. Br J Dermatol 163(2):334-339.
  • Ben-David G, et al. 2008. Pregnancy outcome in women with psoriasis. J Reprod Med 53(3):183-187.
  • Berman M, et al. 2018. The effect of pregnancy on disease activity in patients with psoriatic arthritis. J Rheumatol 45(12):1651-1655.
  • Bobotsis R, et al. 2016. Psoriasis and adverse pregnancy outcomes: a systematic review of observational studies. Br J Dermatol 175(3):464-472.
  • Bröms G, et al. 2018. Effect of maternal psoriasis on pregnancy and birth Outcomes: A population-based cohort study from Denmark and Sweden. Acta Derm Venereol 98(8):728-734.
  • Butler DC, et al. 2014. Safety of dermatologic medications in pregnancy and lactation: Part II. Lactation. J Am Acad Dermatol 70(3):417.e1-10; quiz 427.
  • Caldarola G, et al. 2017. Untreated psoriasis impairs male fertility: A case-control study. Dermatology 233(2-3):170-174.
  • Carman WJ, et al. 2017. Pregnancy and infant outcomes including major congenital malformations among women with chronic inflammatory arthritis or psoriasis, with and without etanercept use. Pharmacoepidemiol Drug Saf 26(9):1109-1118.
  • Cohen-Barak E, et al. 2011. Pregnancy outcomes in women with moderate-to-severe psoriasis. J Eur Acad Dermatol Venereol 25(9):1041-1047.
  • Eudy AM, et al. 2020. Pregnancy outcomes, fertility, and family planning in with psoriatic arthritis. Obstet Med. 13(2)70-75.
  • Gladman DD, et al. 2005. Psoriatic arthritis: epidemiology, clinical features, course, and outcome. Ann Rheum Dis 64 Suppl 2:ii14-17.
  • Harder E, et al. 2014. No increased risk of fetal death or prolonged time to pregnancy in women with psoriasis. Invest Dermatol 34(6):1747-1749.
  • Huerta C, et al. 2007. Incidence and Risk Factors for Psoriasis in the General Population. Arch Dermatol 143(12):1559-1565.
  • Johansen CB, et al. 2022. Psoriasis and adverse pregnancy outcomes: A nationwide case-control study in 491, 274 women in Denmark. JAAD Int 7: 146–155.
  • Kimball AE et al. 2021. Pregnancy Outcomes in Women With Moderate-to-Severe Psoriasis From the Psoriasis Longitudinal Assessment and Registry (PSOLAR) JAMA Dermatol 157(3): 1–6.
  • Meissner Y, et al. 2021. Pregnancy in women with psoriatic arthritis: A systematic literature review of disease activity and adverse pregnancy outcomes. Semin Arthritis Rheum 51(3):530-538.
  • Meserve J, et al. 2021. Paternal Exposure to Immunosuppressive and/or Biologic Agents and Birth Outcomes in Patients with Immune-Mediated Inflammatory Diseases. Gastroenterology 161(1):107-115.
  • Lima XT, et al. 2012. The impact of psoriasis on pregnancy outcomes. J Invest Dermatol 132(1):85-91.
  • Murase JE, et al. 2005. Hormonal effect on psoriasis in pregnancy & post-partum. Arch Dermatol 141(5):601-606.
  • Murase JE, et al. 2014. Safety of dermatologic medications in pregnancy and lactation: Part I. Pregnancy. J Am Acad Dermatol 70(3):401.e1-14.
  • Ostensen M. 1992. The effect of pregnancy on ankylosing spondylitis, psoriatic arthritis, and juvenile rheumatoid arthritis. Am J Reprod Immunol 28(3-4):235-237.
  • Polachek A, et al. 2018. Outcome of pregnancy in women with psoriatic arthritis compared to healthy controls. Clinic Rheum 38: 895-902.
  • Rademaker M, et al. 2018. Psoriasis in those planning a family, pregnant or breast-feeding. The Australasian Psoriasis Collaboration. Australas J Dermatol 59(2):86-100.
  • Remaeus K, et al. 2019. Maternal and infant pregnancy outcomes in women with psoriatic arthritis: a Swedish nationwide cohort study. BJOG 126(10):1213-1222.
  • Raychaudhuri SP, et al. 2003. Clinical course of psoriasis during pregnancy. Int J Dermatol 42(7):518-20.
  • Seeger JD, et al. 2007. Pregnancy and pregnancy outcome among women with inflammatory skin diseases. Dermatol 214(1)32-39.
  • Smith C, et al. 2020. Birth outcomes and disease activity during pregnancy in a prospective cohort of women with psoriatic arthritis and ankylosing spondylitis. Amer Col Rheum 72(7):1029-1037
  • Tuğrul Ayanoğlu B, et al. 2018. Diminished ovarian reserve in patients with psoriasis. Taiwan J Obstet Gynecol 57(2):227-230.
  • Ursin K, et al. 2018. Disease activity of psoriatic arthritis during and after pregnancy: A prospective multicenter study. Arthritis Care Res (Hoboken) 71(8):1092-1100.
  • Yang YW, et al. 2011. Psoriasis and pregnancy outcomes: a nationwide population-based study. J Am Acad Dermatol 64(1):71-77.
  • Yiu ZZ, et al. 2014. Safety of biological therapies for psoriasis: effects on reproductive potential and outcomes in male and female patients. Br J Dermatol 171(3):485-491.
  • Yiu ZZ, et al. 2015. Safety of conventional systemic therapies for psoriasis on reproductive potential and outcomes. J Dermatolog Treat 30:1-6.
  • Yiu ZZ, et αϊ. 2015. Ασφάλεια συμβατικών συστηματικών θεραπειών για την ψωρίαση σχετικά με το αναπαραγωγικό δυναμικό και τα αποτελέσματα. J Dermatolog Treat 30:1-6.