Limited data about the effects of psoriasis therapy during pregnancy make it difficult to know which options are possible for pregnant patients and which ones can be harmful, according to a review.
“During the pregnancy, the decision of treating psoriasis and how to manage the treatment options demands careful thought because the health of both the mother and the foetus must be brought into consideration,” the authors noted.
Many pregnant women with psoriasis can see their symptoms reduce or go away completely but some can see symptoms worsen. As a result, many physicians will recommend patients to seek counseling for their psoriasis symptoms and try to cease therapeutic methods prior to getting pregnant. However, this is not an option or possible to everyone.
Some data does exist for psoriasis drug effects in pregnant women, however, due to ethical concerns about including pregnant women in clinical trials, most data comes from women who realized they were pregnant after entering a psoriasis trial.
The authors said, “although there are several pharmacological therapies available, pregnancy brings ethical concerns and any pharmacological approach must be well thought out.”
For patients with mild psoriasis, topical therapies like moisturizers are well tolerated in pregnant women. The authors said calcineurin inhibitors, anthralin/dithranol, salicylic acid, vitamin D analogues, topical retinoids, and coal tar should all be avoided or taken with caution.
Additionally, coal tar has been associated with spontaneous abortions, congenital disorders, and teratogenicity in animal studies and is recommended to avoid during the first trimester in humans.
Phototherapy methods used for mild to moderate psoriasis should be used with caution as well. Even though narrowband ultraviolet-B (NB-UVB) and broadband UVB rays have not shown to cause fetal abnormalities or premature deliveries, there are concerns that they could create a deficiency in serum folate levels. As a result, overheating should be avoided and folic acid levels should be monitored.
Psoralen plus UVA (PUVA) phototherapy should be avoided due to a few cases where premature labor and fetal abnormalities resulted.
Most oral therapeutic options are either not safe to take during pregnancy or there is limited data; these include methotrexate, ciclosporin, acitretin, and apremilast.
When it comes to considering biological therapies, there is also limited data. However, anti—tumor necrosis factor (anti-TNF) inhibitors seem to be a safe option during pregnancy if a patient is experiencing severe psoriasis symptoms. This includes etanercept, infliximab, adalimumab, and certolizumab pegol.
The authors noted that administration of live vaccines for children should be delayed until the age of 6-12 months if the mother has been taking etanercept, infliximab, adalimumab.
Interleukin biological therapy options such as IL-12, IL-23, and IL-17 should all be avoided in patients who are pregnant and experience severe psoriasis. Data is so limited and sometimes contradictory in these cases that the authors advise to wait until more research has been conducted.
Immunosuppression can happen in both the mother and the fetus, the authors noted.
A general lack of human data for most methods of treating psoriasis in pregnant women means that “future studies will be extremely important to draw further conclusions about the impact of the different therapeutic options on the treatment of psoriasis during pregnancy,” the authors said.
Ferreira C, Azvedo A, Nogueira M, Torres T. Management of psoriasis in pregnancy—a review of the evidence to date. Drugs Context. 2020; 9:1-11. doi: 10.7573/dic.2019-11-6.