New Study: Encouraging News for Pregnant Women With Psoriatic Arthritis

Note: The Pregistry website includes expert reports on more than 2000 medications, 300 diseases, and 150 common exposures during pregnancy and lactation. For the topic Psoriasis, go here. For the topic Rheumatoid Arthritis, go here. These expert reports are free of charge and can be saved and shared.

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About 30 percent of the one million Americans with psoriasis also have arthritis, called psoriatic  arthritis (PsA). Since PsA usually starts during woman’s childbearing years, many women may want to get pregnant with PsA. A new study from researchers at University of California San Diego concludes that these women should be encouraged.

According to the lead author of the study, women with PsA do not face significantly higher risks of adverse pregnancy outcomes than women in the general population.

This is good news, especially if it pertains to you or a loved one, because there has been very little research on PsA in pregnancy. Some research done in psoriasis and rheumatoid arthritis during pregnancy suggests an increased risk for adverse pregnancy outcomes like miscarriage, high blood pressure (pre-eclampsia), pre-term delivery, low birthweight babies, and higher risk of C section.

This study, published in the journal Arthritis Care & Research, compared 117  pregnant women with PsA to over 700 healthy women without PsA (the control group). The only adverse finding was in women with poor PsA disease control at around 32 to 36 weeks of pregnancy. These women had a slightly higher risk of preterm delivery.

There was no link between having PsA and C-section delivery or having a baby that needed neonatal intensive care. The researchers also looked at PsA medications during pregnancy and could not find any problems linked to disease modifying anti-rheumatic drugs (DMARDS) or biologics.

Although some DMARDs are used during pregnancy, others like methotrexate and leflunomide are not used due to a possible increased risk of birth defects. The DMARDs used by women in this study did not increase the risk of premature delivery. One drug that did was glucocorticoid (steroid). This medication is sometimes used to treat a PsA flare, and it may contribute to premature delivery risk.

Overall, this study is welcome news for women with PsA since there was a time when many women with autoimmune diseases like PsA, psoriasis, or rheumatoid arthritis were told that pregnancy was too dangerous. Similarly, when new medications (DMARDs and biologics) came out that could finally alter the course of this disease, there was a fear that none of these drugs would be safe during pregnancy.

There was also a belief that psoriasis and PsA would flare and get worse during pregnancy. No wonder many doctors recommended avoiding pregnancy. Studies have since confirmed that most women do not flare during pregnancy. In fact, more women report that their symptoms either stay the same or improve.

The researchers stress that it is best to talk to your doctors (your OB and your rheumatologist) before planning a pregnancy and to get your disease in as good a control as possible leading up to pregnancy. Ideally, you should get there for several months before you start trying to conceive. The good news is that there is no reason to fear or avoid pregnancy.

Christopher Iliades
Dr. Chris Iliades is a medical doctor with 20 years of experience in clinical medicine and clinical research. Chris has been a full time medical writer and journalist since 2004. His byline appears in over 1,000 articles online including EverydayHealth, The Clinical Advisor, and Healthgrades. He has also written for print media including Cruising World Magazine, MD News, and The Johns Hopkins Children's Center Magazine. Chris lives with his wife and close to his three children and four grandchildren in the Boston area.

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