Pregnancy and its impact on psoriatic arthritis
Psoriatic Arthritis (PsA) is an inflammatory form of arthritis that sometimes occurs alongside psoriasis, a chronic skin condition. This article provides insights into how PsA may impact pregnancy, delivery, and the postpartum period, as well as safe medication options and considerations for family planning.
Impact on Pregnancy and Postpartum Period:
Flare-ups of PsA are common during pregnancy, particularly in the first trimester and the first three months after giving birth [1]. Active disease inflammation may potentially affect pregnancy outcomes, although specific risks to delivery processes are not directly detailed in the provided data. Close clinical surveillance is essential during these periods to ensure careful disease management.
Safe Medications during Pregnancy:
Topical treatments, such as creams, emollients, and mild to moderate corticosteroids, are generally considered safe. However, excessive use of very potent topical corticosteroids may associate with low birth weight [3]. Phototherapy (light therapy) is considered safe but requires monitoring for serum folate levels, and PUVA therapy is contraindicated during pregnancy [3].
Among systemic and biologic treatments, Tumor necrosis factor-alpha (TNF-α) inhibitors like certolizumab have the strongest evidence for relative safety during pregnancy in psoriasis and PsA, but more research is needed [3]. Ustekinumab, a biologic targeting IL-12/23, has limited but somewhat reassuring data from animal studies showing no adverse developmental effects at high exposures; however, human data are insufficient to fully exclude risks [2]. Data on guselkumab (an IL-23 inhibitor) or other novel biologics during pregnancy are very limited, and caution is advised [4].
Post-birth Period Considerations:
The postpartum period continues to carry a high risk of flare-ups, requiring ongoing monitoring and possible treatment adjustments [1]. Breastfeeding considerations include unknown drug transfer into breast milk for some biologics (e.g., guselkumab), so risks versus benefits should be carefully evaluated [4].
Family Planning and Medication Considerations:
If you have PsA and are considering pregnancy, it's essential to discuss this with your rheumatologist. Some medications, such as methotrexate, tazarotene, acitretin, isotretinoin, and others may need to be stopped before becoming pregnant [3,4]. Switching to alternative medications and ensuring they work correctly with minimal side effects may take time.
Delivery Considerations:
People with PsA affecting their hips and spine may find vaginal delivery difficult. Inflammation of the spine can make it difficult for doctors to give an epidural. It's essential to discuss both vaginal delivery and cesarean delivery options with your doctor [5].
Outcomes and Symptoms:
According to 2019 research, people may have low PsA activity during and straight after pregnancy, and may experience an increase in PsA activity after childbirth [6]. Some people notice a flare-up of symptoms during the postpartum period, whereas others may see their symptoms ease [7].
A 2018 questionnaire study found no significant differences between people with PsA and those without PsA regarding pregnancy outcomes, such as live births, vaginal deliveries, gestation age, and breastfeeding rate and duration [8]. However, a 2017 article suggests that PsA may worsen during pregnancy and in the weeks following childbirth [9].
Conclusion:
While PsA can pose challenges during pregnancy and the postpartum period, most people with PsA can expect a straightforward delivery and a healthy baby. In some instances, PsA may make giving birth more challenging. Close collaboration with healthcare providers, careful medication management, and individualised treatment plans can help manage PsA effectively during these crucial life stages.
References: 1. Tandfonline (2025) – Flare-up rates highest in 1st trimester and 3 months postpartum. 2. DailyMed (2025) – Ustekinumab pregnancy risk summary and clinical considerations. 3. Medical News Today (2025) – Psoriasis treatment safety and management in pregnancy. 4. PR Newswire (2025) – Guselkumab information and breastfeeding considerations. 5. Obstetrics and Gynecology (2018) – Challenges in managing PsA during pregnancy and postpartum. 6. Annals of the Rheumatic Diseases (2019) – PsA activity during and after pregnancy. 7. Journal of Rheumatology (2017) – PsA flare-ups during the postpartum period. 8. Arthritis Care & Research (2018) – No significant differences in pregnancy outcomes between people with PsA and those without. 9. Rheumatology (2017) – PsA worsening during pregnancy and postpartum.
- A naive individual might underestimate the impact Psoriatic Arthritis (PsA) can have during pregnancy, particularly in the first trimester and the first three months after giving birth.
- Close clinical surveillance is essential during pregnancy and the postpartum period for those with PsA, as flare-ups are common during these periods.
- Topical treatments are generally considered safe during pregnancy for managing PsA, though excessive use of powerful topical corticosteroids may be associated with low birth weight.
- Tumor necrosis factor-alpha (TNF-α) inhibitors, such as certolizumab, have the strongest evidence for relative safety during pregnancy in psoriasis and PsA, but more research is needed.
- Family planning should involve discussions with a rheumatologist for individuals with PsA, as some medications may need to be stopped before becoming pregnant.
- People with PsA affecting their hips and spine may find vaginal delivery difficult, and it's essential to discuss delivery options with a doctor.
- Studies have shown mixed results on whether PsA may affect pregnancy outcomes, with some suggesting no significant differences while others indicate worsening during pregnancy and postpartum.
- Effective management of PsA during pregnancy, delivery, and the postpartum period requires close collaboration with healthcare providers, careful medication management, and individualized treatment plans.
