What to Know About Psoriatic Arthritis and Pregnancy

Fertility, Gestation, and Postpartum

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Psoriatic arthritis (PsA) is a chronic inflammatory disease of the joints and the areas where tendons and ligaments connect to bone. Inflammation with PsA can lead to swelling, pain, and stiffness of the joints. Left untreated, PsA can cause permanent joint damage and disability. 

The decision to start a family is one of the most important decisions you and your partner will ever make. But when you have PsA, there is a lot to consider when making this decision.

The good news is that for most people, PsA shouldn’t get in the way of family planning. Keep reading to learn more about fertility, pregnancy, delivery, and beyond for people living with PsA.

Psoriatic arthritis and pregnancy

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Psoriatic Arthritis and Fertility

Fertility is defined as the ability to conceive and the ability to become pregnant from sexual intercourse. There is no evidence that PsA affects fertility.

The latest research on PsA and fertility finds that people with PsA can get pregnant just as easily as people without the condition. Also, having PsA doesn’t affect the health of the unborn fetus.

A study reported in 2019 in the journal Clinical Rheumatology relied on questionnaires from 74 women with PsA and 74 without PsA. The women were asked if they were diagnosed with infertility in the past, the type of delivery they had, their newborn’s weight, whether their baby was full-term, and if there were pregnancy-related complications. 

From the information received and reviewed, researchers concluded that PsA did not affect fertility and that having the condition did not lead to worse pregnancy outcomes.

The study also found 58% of people with PsA had improved joint symptoms during pregnancy. Unfortunately, symptoms returned and worsened after delivery for many of the study participants. 

While a study like this one is very promising, you should still talk to the doctor who treats your PsA if you are considering getting pregnant or you have learned you are pregnant.

A physician will need to adjust your treatment because some medications used to treat PsA, like methotrexate, can be dangerous to the fetus.

Methotrexate and Cyclophosphamide

Methotrexate is discontinued three months prior to trying to conceive given that it is teratogenic to a fetus (can cause birth defects). It would also be discontinued immediately if you are found to be pregnant while taking it.

Cyclophosphamide also is extremely teratogenic to a fetus and would not be recommended if trying to conceive or if pregnant.

There has also been some evidence that some disease-modifying antirheumatic drugs (DMARDs), including cyclophosphamide and sulfasalazine, may reduce sperm quality. Fortunately, researchers believe the effect can be reversed by stopping those treatments.

There are other therapies for treating PsA, including many different disease-modifying drugs known as biologics, that will not affect male fertility. 

Psoriatic Arthritis and Gestation

Gestation is the time between conception and birth. The fetus grows and develops in the womb (uterus) during this period. At this time, there are additional considerations for people with PsA, including those related to risks, treatment, and symptoms. 

Risks 

PsA on its own during pregnancy usually doesn’t have significant negative effects on the pregnancy or the unborn fetus. But studies on pregnancy outcomes in PsA are few and most of these are small in size or have conflicting results.

A 2019 Swedish study aimed to describe maternal pregnancy and infant outcomes in people with PsA compared to people without PsA. Researchers gathered information from national and population registries on individual pregnancies and compared outcomes.

They found the majority of pregnancies with PsA were uneventful, meaning there were no harmful outcomes. However, researchers did note an increased risk for preterm birth (being born before 37 weeks of pregnancy) and the need for cesarean section (C-section) deliveries compared to non-PsA pregnancies. 

Cesarean Section (C-section)

A C-section is a surgical procedure to deliver a baby by making incisions in the abdomen and uterus. C-sections are sometimes necessary when problems arise during pregnancy or delivery or for those who have had a C-section in the past.

Some research has found that PsA might be related to an increased risk for diabetes, hypertension (high blood pressure), and preeclampsia in pregnancy.

Preeclampsia a common pregnancy complication that causes high blood pressure and protein in the urine. It can affect the unborn fetus by reducing the amount of blood that flows through the placenta. 

Findings for a study reported in 2018 in Advances in Dermatology and Venereology revealed this connection. This study also confirmed an increased need for elective or emergency C-section deliveries and a higher risk for preterm birth or low birth weight. 

According to the study authors, many of these connections had never been previously reported. They further noted unhealthy lifestyle choices can also contribute to these negative effects in people with PsA and psoriasis.

The study did offer some good news, reporting that people with PsA and psoriasis can take steps to limit outside risk factors and thereby reduce their risk for negative outcomes in pregnancy. 

Psoriasis

Psoriasis is an autoimmune skin condition in which skin cells build up and form itchy, dry, and inflamed skin patches called plaques. A 2019 review of studies estimated that PsA affects about 25% of people who have psoriasis.

Treatments

If you are pregnant, the treatment of PsA must be tailored to your needs and those of your developing fetus. Most doctors will reduce the number of PsA medications you take and their dosages during pregnancy. Your doctor might also want you to stop taking certain drugs in favor of ones that are safer during pregnancy.

Among DMARDs, sulfasalazine and cyclosporine are considered safer than other PsA treatments. One study reported 74% of women who used sulfasalazine during pregnancy did not have an increase in birth defects, confirming prior studies.

Prednisone is safe during pregnancy but dosing would be at the discretion of your healthcare professionals (ob-gyn or rheumatologist), depending on the severity of disease and the trimester you are in.

The National Psoriasis Foundation released treatment guidelines in 2012 for people who are pregnant or breastfeeding. In this report, the foundation concluded that some systemic and biologic drugs should be avoided during pregnancy because those drugs are linked to birth defects and miscarriage.

Newer research seems to suggest the risk of biologics during pregnancy might be overestimated. A 2018 study in Annals of the Rheumatic Diseases reports that using biologics to treat autoimmune diseases during pregnancy does not appear to increase the risk for preterm birth or low birth weight.

Certolizumab is one of the safest TNF inhibitors (drugs that help stop inflammation) and is OK to continue during pregnancy. Your rheumatologist may consider holding off the use of others, such as Humira (adalimumab), during the last one to two months of pregnancy to limit transfer to the fetus.

Biologics that target interleukin (IL) proteins, such as Kineret (anakinra), are used with caution since there is a lack of data regarding their risks for birth defects or miscarriage. Most healthcare professionals would advise you to discontinue these drugs during pregnancy.

Your rheumatologist and obstetrician are the best sources of information when it comes to pregnancy planning and pregnancy care with PsA. They can best advise on treatments for your PsA during your pregnancy based on your unique health situation.

Psoriatic Arthritis Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

Pregnant person and doctor

Symptoms 

One study reported in 2017 in the journal Seminars in Arthritis and Rheumatism, looked at 42 pregnancies in 29 women with psoriatic arthritis. That study found PsA either improved or stayed stable in 58% of pregnancies. In about 88% of cases, skin symptoms improved or stayed stable. 

PsA worsened in 32% of the pregnancies. The remainder of the pregnancies had a mixed pattern of improvement that later got worse.

If your PsA worsens during pregnancy, you might see an increase in symptoms or increase in disease severity. Joint pain and swelling might be aggravated by the weight of your developing baby. 

You might also experience PsA pain and symptoms in your back and spine because of changes related to your growing belly. And since PsA and pregnancy both cause fatigue, it is not unusual for PsA fatigue to worsen during pregnancy. 

Prevalence of Psoriatic Arthritis During Pregnancy

According to a 2015 report in the Brazilian journal Annals of Dermatology, there are 107,000 deliveries performed annually on pregnant women with either psoriasis, PsA, or both. Of these pregnancies, up to 15,000 people have moderate to severe disease.

Pregnancy can trigger PsA in people who have psoriasis. And up to 40% of people experience a new onset of PsA during the postpartum period.

Psoriatic Arthritis and Postpartum

Most people with PsA can have safe deliveries and healthy babies. They might experience worsening symptoms after delivery, but flare-ups can be addressed before they harm postpartum recovery. There are also some precautions you will want to take if you are planning to breastfeed your baby.

Postpartum

Postpartum refers to the period following childbirth. It begins immediately after childbirth, as the mother’s body, including hormone levels and uterus size, returns to its prepregnancy state.

Impact on Recovery 

If you notice your symptoms get worse after delivery, you should reach out to your rheumatologist. Research shows that many people with PsA will experience a flare-up in their disease after they give birth, although it may not happen right away. A flare-up is a time when PsA symptoms get worse. 

A study reported in 2019 in the journal Arthritis Care & Research found that disease activity in PsA worsened about six months after childbirth. In this study, Norwegian researchers followed 100 women with PsA and evaluated them at several points before, during, and after pregnancy.

Most people studied—around 75%—experienced remission (no disease activity) or low disease activity during pregnancy and right after. But six months after delivery, disease activity was significantly increased. 

The study’s authors concluded that while disease activity increased, there is no reason to assume that symptoms and disease activity cannot be managed or reduced. Talk to your doctor about updating your treatment plan and let your doctor know about disease changes and new symptoms, including back pain and stiffness. 

Impact on Breastfeeding 

There is a lack of research about medication safety during breastfeeding. You should talk to your rheumatologist, dermatologist, or other treating physician about how PsA therapies might affect breast milk. You should also avoid using topical treatments around your nipples so your baby doesn’t ingest these products.

When breastfeeding, the first-line (initial) therapies for psoriasis are limited to creams and low-potency corticosteroids. There are no known risks from topical treatments for a breastfeeding mother and the child. These treatments should be applied after breastfeeding and removed before breastfeeding.

Phototherapy, a second-line therapy for managing skin symptoms of PsA and psoriasis, is also believed to be safe while breastfeeding. But there are no studies to confirm this.

Systemic therapies like methotrexate for managing PsA might not be safe for use while breastfeeding. Studies on systemic therapies, including biologics, have found low or minimal concentrations of these drugs in breast milk.

But because there is no consistent data on how systemic therapies might pass through breast milk, your PsA treating physician is in the best position to give you advice on the safety of these drugs and the pros and cons of each treatment.

The decision as to how to treat PsA while you are breastfeeding is a personal one. Should you need treatment after you have a baby, work with your doctor to determine which treatment options might be best for your unique health situation.

Frequently Asked Questions 

How does pregnancy affect psoriatic arthritis symptoms? 

Pregnancy could mean a reprieve from your PsA joint and skin symptoms, although there is a chance your PsA could worsen or flare up during pregnancy. The condition tends to remain stable during pregnancy. However, worsening symptoms are also common after delivery.  

Does psoriatic arthritis affect how you can care for children? 

According to the National Psoriasis Foundation, PsA tends to occur in people between the ages of 30 and 50. This means that many of the people affected by PsA are just starting their families or are parenting young children. It is challenging to juggle your care needs with those of your child.

Working with your doctor to manage PsA symptoms is vital. Remember flares are temporary and there are ways to adjust routines and activities around PsA while still caring for your child. Staying healthy and on top of your care will not only help you manage your PsA, but it will set a good example for your little ones. 

How likely is it that your baby will inherit psoriatic arthritis?

There is a genetic component to psoriatic arthritis, so it is possible for a parent to pass the condition on to a child. While an inheritance pattern for PsA is unknown, up to 40% of people with PsA have a family member with either PsA or psoriasis.

PsA is also linked to certain environmental triggers. For this reason, it is impossible to predict whether your child will have PsA later in life. And it is important to note that many people with PsA and other autoimmune diseases do have healthy babies that never go on to develop PsA, psoriasis, or another autoimmune disease.

Summary

Psoriatic arthritis does not affect your ability to become pregnant, although some drugs used to treat it may reduce sperm quality. Some studies have shown an increased risk for certain pregnancy complications.

People often have fewer PsA symptoms during pregnancy, although they are likely to return after delivery. If you are pregnant, the medications to treat PsA may be adjusted to reduce risks to the fetus. They may also need to be adjusted if you are breastfeeding.

A Word From Verywell 

Taking care of yourself before getting pregnant, while pregnant, and after your baby is born is important if you live with psoriatic arthritis. Make sure you are taking your medicines as prescribed and that you adjust to any changes your doctor may advise.

You can also cope by eating healthy, taking naps when your baby is napping, and getting help from your partner, family, friends, and even paid help so that you can better deal with the challenges that arise.

Being a parent is difficult, but parenting comes with many unique rewards as well. Taking good care of yourself and managing your PsA can help to ensure your ability to care for your child.

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