Psoriasis during pregnancy: medication guide

By trimester

Weeks 1–13

1st trimester

This is the highest-priority window to have already sorted out which medications are compatible, since methotrexate, acitretin, and cyclosporine carry birth defect risk and are meant to be stopped before conception rather than after a positive test.

Weeks 14–27

2nd trimester

If a biologic is part of your plan, this is a reasonable point to review dosing and timing with your dermatologist, including how upcoming doses relate to your due date.

Weeks 28–birth

3rd trimester

Discuss the timing of any biologic doses relative to delivery, since a dose given late in pregnancy can still be active in your newborn's system afterward, which matters for the infant's own care team to know.

What does the evidence show for psoriasis?

• Across five reviewed studies, psoriasis itself was not found to increase the chance of birth defects, while whether psoriasis or psoriatic arthritis raises miscarriage risk remains unclear. 1
• The effect of psoriasis on preterm delivery and low birth weight is inconsistent across studies, and may depend on how severe the disease is and other individual health factors rather than the assessment alone. 1
• Decisions about psoriasis medication during pregnancy are generally made case by case, with no single defined point in gestation set as a cutoff for stopping a given drug. 2
• Methotrexate, acitretin, and to some extent cyclosporine are avoided for anyone planning a pregnancy because of their potential to cause birth defects, which rules out these conventional systemic options well before conception rather than only in the first trimester. 2
• Certolizumab pegol lacks the antibody structure that most other biologics use to cross the placenta, resulting in minimal transfer to the fetus compared with complete-structure biologics like adalimumab or infliximab. 2
• Available data on TNF-inhibitor biologics has not shown an increase in birth defects or miscarriage with maternal use, which supports considering them for moderate-to-severe psoriasis when a pregnancy is planned or underway. 3
• For biologics that do cross the placenta, a key question is how much immune suppression the infant carries in the first few months of life, since a dose given late in pregnancy can remain active in a newborn's system after birth. 3
• Outside of pregnancy, psoriasis management generally follows a tiered approach: milder disease is often managed with creams or ointments, while moderate to severe disease may call for pills, injections, or light-based approaches. 4

Common psoriasis medications and pregnancy considerations

When should I call my provider about psoriasis?

A severe flare with widespread skin breakdown, weeping, or signs of infection such as increasing redness, warmth, pus, or fever needs prompt evaluation, especially while on an immune-suppressing medication.,New joint pain, swelling, or stiffness can signal psoriatic arthritis and deserves its own evaluation rather than being folded into skin-only care.,Fever or other signs of infection while taking a biologic or other immune-suppressing medication needs prompt medical attention rather than waiting to see if it passes.,Stopping a systemic medication abruptly without medical guidance, especially around conception, can allow a severe flare; any medication change should go through your prescriber. None of these lists replace your own judgment: if this symptom worries you, that on its own is enough reason to check in with your healthcare provider.