Hesitant To Start A Family Because You Or Your Spouse Suffer From Psoriasis?
Having a baby is understandably a huge decision to make. If you suffer from psoriasis, you have even more things to consider. Before conceiving, you may worry if you can even get pregnant. Moreover, what are the chances your child inherits psoriasis from you (or your spouse)?
Be prepared to face psoriasis symptoms and understand how they present at all stages of pregnancy, including childbirth, and after you give birth (like when you’re breastfeeding).
Find out what our trusted dermatologist, Dr Peter Ch’ng, says, as he answers your burning questions, weighs in on the risks of pregnancy complications with psoriasis, and recommends treatment for varying degrees of psoriasis during pregnancy.
The Real Impact Of Psoriasis On Pregnancy
Can you get pregnant if you have psoriasis ? Having psoriasis does not impact your reproductive health or chances of getting pregnant. Moreover, there hasn’t been any link between psoriasis disease itself and birth defects or miscarriage. However, one study in the Journal of the American Academy of Dermatology found that women with severe psoriasis were more likely to have a baby with low birth weight than those without psoriasis. 1
The real issue is whether your medications for treating psoriasis are going to affect conception and pregnancy. As we’ll cover in more detail, some drugs may be perfectly safe, but others should be avoided during pregnancy as they may lead to miscarriage and birth defects. Before embarking on conception please discuss this thoroughly with your doctor. Some of your medications may have an impact on your fertility, sperm, or your baby’s growth. Plan for an appropriate washout period (if necessary) before you try to conceive. And be aware of safe treatments to manage your flare-ups during pregnancy and while nursing. 2
What is the likelihood that your child gets psoriasis? It’s not a guarantee. First your child must be passed the gene and the gene must be ‘switched on’ by an environmental trigger like infection or stress. If you and your spouse both have psoriasis, then the risk that your child develops it is 65%. If only one of you has psoriasis, the risk drops to 25%. However even if you pass on the gene it doesn’t 3 mean it will be active; scientists believe 10% of the population inherits this gene but only 2-3% ever develops the disease. 4
How does psoriasis change during pregnancy? The answer is, it depends. On a case-by-case basis, women experience either less severe symptoms of psoriasis, or worse flare-ups during pregnancy. Doctors and researchers believe these differences may be due to hormone changes within each woman. Medications 5 should be limited during pregnancy and nursing. If you have psoriatic arthritis, you can’t go off medications entirely, so you need to discuss with your doctor about safe medications.
Childbirth and post-pregnancy: If you have a C-section, you might get a flare up of psoriasis symptoms (what doctors call the Koebner phenomenon) due to the injury on your body. Many women report a psoriasis flare shortly after delivery. Some women get psoriasis for the first time after pregnancy. If you already have it and get pregnant, there’s a chance that you may develop psoriatic arthritis after your baby is born. You may also experience breastfeeding problems if the skin on or around your breasts is affected. Always tell your doctor about your symptoms.6
Treatment Options Available to Psoriasis Patients During Pregnancy
Adopt a stepwise approach to managing psoriasis to keep you and your baby safe. During this period, the dose, number of medications, and frequency of administration should only increase as necessary and be decreased where possible. With the help of your doctor, choose your treatment plan carefully according to the severity and type of psoriasis you have. You should also consider co-morbidities, response to therapy (the changes in your Psoriasis medication, may affect other conditions you might be suffering from), costs, and convenience.7
If you have mild psoriasis: Topical treatments are recommended as a first line of treatment, moisturizers can be used in abundance.
If this isn’t enough, try mild topical corticosteroids. Follow this up with stronger topical corticosteroids (only if needed) in your second and third trimesters. These agents are much safer for pregnancy compared to calcipotriene or coal tar.8
If you have moderate to severe psoriasis: Opt for Narrowband Ultraviolet B (UVB) phototherapy, which works better and is safer than oral treatments. Although UVB has no official pregnancy category designation by the FDA, UV light penetration is limited to the mother’s skin and therefore not thought to be dangerous to the foetus.9
If you have very severe psoriasis: Cyclosporin (FDA Category C) has been used by pregnant women with successful outcomes. However, there have been instances of low birth weight and prematurity. There is increasing evidence to support the use of some biologic agents (FDA pregnancy category B) during pregnancy. One may consider biologic agents for severe, treatment-refractory psoriasis during pregnancy.
Avoid these drugs: Pregnant or nursing, you’ll want to avoid exposure to harmful drugs such as psoralens (FDA Category C) and ultraviolet A light (PUVA), methotrexate, and acitretin (FDA Category X). These drugs lead to birth defects and mutations (methotrexate is also abortive) and can be passed on to newborns via breastfeeding.10
FDA Pregnancy Risk Categories11
|A||Adequate and well-controlled studies have failed to demonstrate a risk to the fetus in the first trimester of pregnancy (and there is no evidence of risk in later trimesters).|
|B||Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women.|
|C||Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks|
|D||There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.|
|X||Studies in animals or humans have demonstrated fetal abnormalities and/or there is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience, and the risks involved in use of the drug in pregnant women clearly outweigh potential benefits.|
Manage Your Psoriasis Safely And Have A Healthy Baby – The takeaway
Rest assured psoriasis does not affect your chances of getting pregnant. However, managing treatments and limiting your exposure to harmful drugs before, during, and post-pregnancy is important. There may be risks of flare-ups during childbirth if you have a C-section, and you may get new symptoms post-pregnancy.
Be smart and inform your obstetrician or midwife if you currently have psoriasis or have had it in the past. Discuss your pregnancy plans and treatment options with your doctor. Remember to avoid those usual culprits that trigger your psoriasis during pregnancy such as alcohol, smoking, and stress. 12
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If you enjoyed this article, read Biologic Treatment For Psoriasis: 4 Tips You Should Know
Dr Ch’ng obtained his specialty training from the Royal College of Physicians in London. Subsequently, he obtained his Advanced Masters in Dermatology from the National University of Malaysia. He was previously the Head of Dermatology of the State of Pahang and Hospital Sungai Buloh.
His call to dermatology started way before he even contemplated doing medicine. His father suffered from severe psoriasis, and was in and out of hospital a lot in the late 1970s. His father’s condition made him see that skin disease is not just an aesthetic problem, as it can cause the patient and the entire family so much grief. His practice today reaffirms his belief, with many patients expressing deep relief and gratitude after their treatment.
Place of Practice
Dr. Ch'ng is a NSR registered consultant dermatologist. She graduated as a gold medalist from Univeristy Malaya in 2006. She obtained Membership of the Royal Colleges of Physician of the United Kingdom in 2010 and joined dermatology team in University Malaya in the same year. She completed Advanced Master in Dermatology (UKM) in 2014 and a visiting fellowship in Cutaneous Laser Surgery in Mahidol University (Thailand) in 2017. Her special interest include acne, psoriasis, urticaria, contact dermatitis/eczema and procedural dermatology.
Dr. Ch'ng started her instagram account @cccskindoc providing free skin care tips and education to public. She believes everyone deserves up-to-date and accurate information on skin care to embrace the skin that he or she is in.
Place of Practice
Dr Khor graduated from National University of Malaysia (UKM), Kuala Lumpur in 2002. He obtained his Internal Medicine specialty training from the Royal College of Physicians of London in 2007 and further subspecialized in Dermatology by obtaining his Advanced Master in Dermatology from UKM in 2013. Dr Khor served as the Head of Dermatology service for Perlis from 2013 to 2015 before transferring back to Penang. Currently, he is the Deputy Head of Department of Dermatology in Hospital Pulau Pinang. He is also a visiting consultant dermatologist at KPJ Penang Specialist Hospital and Northern Skin Specialist Clinic.
Dr Khor is active in academic activities, performing as an honorary lecturer for Allianze University College of Medical Sciences and Penang Medical College. He is active in research as well with the publication of original papers in dermatological journals and serves as a reviewer for Malaysian Journal of Dermatology. His dedication to the profession earned him Excellent Service Award from the Ministry of Health in 2009 and 2017.
Place of Practice