As half of all pregnancies go unplanned, patients and providers must understand the implications of therapeutic options in all women with psoriasis who are sexually active, whether or not they plan to start a family, according to researchers.
“There is also a need for better information of [health care professionals] with respect to therapeutic options for women of reproductive age, particularly in light of the increasing safety data available for biologic therapies, and for the establishment of formal treatment guidelines,” Alice B. Gottlieb, MD, PhD, of the department of dermatology at Icahn School of Medicine at Mount Sinai, and colleagues wrote.
In women, a diagnosis of psoriasis and therapy commencement often coincide with peak reproductive years. Most patient with psoriasis (88%) who plan to become pregnant sought advice from the internet and only 21% consulted their physician, based on National Psoriasis Foundation survey results.
Previous studies have reported a 22% lower likelihood of pregnancy among women with psoriasis, whereas a 2016 study found no clear evidence of an increased risk for adverse pregnancy outcomes in this population.
“However, certain studies have found a link between disease activity and pregnancy complications or adverse pregnancy outcomes,” Gottlieb and colleagues wrote. “An increased risk of gestational diabetes, gestational hypertension, preeclampsia and emergency cesarean delivery was reported in women with [psoriasis].”
Additionally, the researchers added that pregnancy outcome data for women with psoriatic arthritis is even more limited. An increase in gestational hypertension and preeclampsia was identified in a 2017 study. However, a Swedish study from 2018 did not identify a difference in the adjusted OR of preeclampsia, gestational diabetes and stillbirth between groups.
Discontinuation of biologic treatment before pregnancy or during the first trimester coincides with significant disease worsening during pregnancy and postpartum, but no significant changes were reported in a small number of patients who continued biologic therapy beyond the first trimester, according to the study.
Nursing mothers are prone to nipple pain due to dermatitis and the development of new psoriasis plaques. As for topical therapies, the use of class 1 corticosteroids on the nipples should be avoided, according to researchers. Moreover, psoralen and UVA therapy is contraindicated during pregnancy.
“Psoriasis and psoriatic arthritis management before, during and after pregnancy is highly important to achieve optimal outcomes for both mothers and infants,” Gottlieb and colleagues wrote.
Oral treatments such as oral psoralen, methotrexate and acitretin should be avoided in pregnancy because they have been linked to teratogenic effects.
As for biologic therapies, “the Fc-free anti-TNF certolizumab pegol (CZP) [Cimzia, UCB] is the only biologic agent with clinical trial data in its label supporting potential use in both pregnancy and breastfeeding or chronic inflammatory disease,” they wrote.
Humira (adalimumab, AbbVie) and Enbrel (etanercept, Amgen) were updated to allow potential use during pregnancy, while it is understood that they may cross the placenta, according to researchers.
However, Stelara (ustekinumab, Janssen) and Cosentyx (secukinumab, Novartis) are typically avoided during pregnancy as a precautionary measure, due to the lack of data on use in pregnant women.
Researchers added that biologics are considered for use while breastfeeding.
As the onset of psoriasis in women often coincides with prime reproductive years, specific treatment challenges must be addressed and handled adequately, according to researchers. – by Abigail Sutton
Disclosures: Gottlieb reports she is a consultant, advisory board member and/or speaker for AbbVie, Allergan, Avotres Therapeutics, Beiersdorf, Bristol-Myers Squibb, Celgene, Dermira, Eli Lilly, Incyte, Janssen, Leo, Novartis, Reddy Labs, Sun Pharmaceutical Industries, UCB Pharma and Xbiotech. Gottlieb also reports receiving research/educational grants from Boehringer Ingelheim, Incyte, Janssen, Novartis and Xbiotech. Please see the study for all other authors’ relevant financial disclosures.