Psoriatic arthritis can cause painful, swollen joints in some people with psoriasis. The condition and certain medications that people are taking for it may have some effects on pregnancy.
Psoriatic arthritis (PsA) is an inflammatory form of arthritis that sometimes occurs alongside psoriasis, a chronic skin condition. PsA can cause painful and swollen joints.
This article will outline the effects of PsA medications on fertility and pregnancy, whether PsA can affect delivery or the health of a baby, and how pregnancy and childbirth can affect PsA symptoms and disease activity.
A note about sex and gender
Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.
According to the Arthritis Foundation, PsA does not affect the ability to become pregnant. This means people who use birth control should continue doing so. A person should then talk with their rheumatologist about family planning if they would like to try and become pregnant.
It can take time to switch to alternative medications and ensure they work correctly with minimal side effects.
During family planning, people can discuss with their doctor which PsA medications are safe to continue taking if they are planning a pregnancy.
People will need to talk with their doctor about stopping the PsA drug methotrexate before becoming pregnant. They may also need to discuss stopping the following medications for psoriasis:
- tazarotene
- acitretin
- isotretinoin
For most PsA medications, once a person stops taking the drug and it has left the bloodstream, it will pose no risk to fetal development.
A small 2019 survey of 40 females with PsA between ages 20–50 years looked at the effects of PsA on fertility.
The questionnaire results showed that
According to a 2019 systematic review, certain disease-modifying antirheumatic drugs (DMARDs) may affect male fertility. Cyclophosphamide and sulfasalazine may harm sperm quality.
The review found no firm evidence that other DMARDs posed any risk to male fertility.
Research into pregnancy outcomes for people with PsA is contradictory. On the whole, researchers agree that PsA can lead to an increased likelihood of preterm birth and cesarean delivery. However, it is unclear whether there is an association between PsA and other outcomes such as preeclampsia and low birth weight.
A 2021 systematic review of PsA in pregnancy suggests there may be an increased risk of preeclampsia, elective cesarean, and preterm birth for pregnancies in people with PsA. The research found no increased risk of gestational diabetes or low birth weight.
A
There were no increased risks of preeclampsia, stillbirth, or other adverse outcomes in pregnancies of people with PsA.
The study concluded that most people with PsA have pregnancies with no significant adverse outcomes.
If PsA affects a person’s back or hips, they may experience more pain in those areas as the baby grows and puts pressure on the joints. A person may also experience more fatigue than someone without PsA.
According to a 2017 study published in Seminars of Arthritis and Rheumatism, a person with PsA might find that pregnancy affects their PsA symptoms. Of 42 pregnancies, 58.5% of participants experienced reduced or low-level stable symptoms during pregnancy.
However, a 2017 article states that PsA may worsen during pregnancy and in the weeks following childbirth.
According to 2019 research, people may have low PsA activity during and straight after pregnancy. They may also experience an increase in PsA activity
The research suggests that PsA activity was manageable from the beginning of pregnancy to one year postpartum.
Most people with PsA can expect a straightforward delivery and a healthy baby. In some instances, PsA can make giving birth more challenging.
If PsA affects a pregnant person’s hips and spine, they may find vaginal delivery difficult. Inflammation of the spine can make it difficult for doctors to give an epidural, the injection that numbs the lower half of the body during delivery.
A person can talk with a doctor about their options for giving birth. This might include discussing both vaginal delivery and cesarean delivery.
The postpartum period can be exhausting, and PsA may make fatigue worse. It is important to make sure a person has a support system during the postpartum period in case a flare-up of symptoms makes it difficult to care for the baby.
Some people notice a flare-up of symptoms during the postpartum period, whereas others may see their symptoms ease.
In a small 2017 study, 52.5% of people had reduced or stable low disease activity during the postpartum period. 40% reported worsened symptoms or stable high disease activity.
People should contact a doctor if they notice any changes in their symptoms or any new aches and pains.
PsA symptoms may seem similar to other aches and pains that can come with being a new parent, such as breastfeeding pains.
In some cases, people may need a change to their medication.
Most PsA medications are safe for breastfeeding, though not all. People can talk with a doctor to find out which medications are safe during breastfeeding.
Having PsA means a person has extra considerations around pregnancy. However, the chances of having a healthy pregnancy, birth, and postpartum period are good.
A 2018 questionnaire study looked at pregnancy outcomes in 74 people with PsA and 74 people without PsA.
The study found no significant differences between the two groups regarding:
- number of pregnancies, children, or infertility diagnosis
- live births
- vaginal deliveries
- gestation age
- weight at birth
- rate of maternal complications, or those affecting the fetus
- breastfeeding rate and duration
In 50% of cases, people reported worsening joint symptoms during the first year after childbirth.
The study concluded that people with PsA do not have worse infertility or pregnancy outcomes than those without PsA.
People with PsA can expect to have a healthy pregnancy. However, they may need to speak with their doctor about adjusting their medication before trying to become pregnant.
Pregnancy can increase pressure on the joints, which may cause pain. People with pain and inflammation in the hips and back might find vaginal delivery difficult.
There is no evidence of a significantly increased risk of adverse pregnancy outcomes for people with PsA or their children. However, PsA may increase the risk of preterm and cesarean delivery.