Fertility, Conception and Pregnancy

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Planning ahead

Having psoriasis or psoriatic arthritis does not affect your chances of getting pregnant. The decision to get pregnant rests entirely with you and your partner.

Before embarking on conception please discuss this thoroughly with your doctor or health team.

Will any medications have an adverse effect on conception and the development of a baby?

Yes, some medications are not recommended during or prior to conception therefore you should discuss any planned or unplanned pregnancies with your doctor and appropriate contraception should be in place.

Some medications may have adverse affects on a developing baby in the womb, if you are still taking such medications at the time of conception. This is why a “wash-out” period may be needed to make sure they are cleared from the body to allow every chance of a healthy baby. This is an essential precaution for you to embark on a healthy, happy pregnancy.

However, careful consideration should be made and any precautions taken in good time to ensure healthy conception leading to a healthy pregnancy. This is because some psoriatic treatments may need to be stopped with a time lapse before conception takes place to avoid any unnecessary fertility or birth problems.

If a certain length of time has lapsed in trying to conceive without success you should always go back with your partner and discuss this as there may be other unconnected issues that may need investigating further on either side.

Do Contraceptive birth pills have any effects on psoriasis/psoriatic arthritis?

Contraceptive pills work by controlling a women’s hormones and can have both good and bad effects on a person’s body depending on the individual and because everyone is different there is no way of predicting such outcomes.

Conception

Will having genital psoriasis affect conception?

No, having genital psoriasis will not cause any problems, only if you are very sore and uncomfortable and this prevents you having intercourse.

If my partner has psoriasis/psoriatic arthritis will the medications he is taking affect our conception efforts?

He should discuss the medications he is on with this doctor before attempting conception in case he needs to have a “wash-out” period of certain drugs that may affect sperm quality or have any consequences to sperm abnormalities. His doctor should be able to advice on these questions.

Pregnancy

Is it important that my midwife, medical team are aware that I have psoriasis/psoriatic arthritis?

Yes because they can help in the planning of your medical care and be prepared for any additional help that you made need if you should experience a flare-up, or indeed, to try and make the necessary steps to help you prevent one by not getting too stressed. They can also make sure any others who care for you will know your medical background too.

Will psoriasis or psoriatic arthritis affect my pregnancy?

There is no reason why it should interfere with you having a normal pregnancy and delivery. However, it is important to plan ahead. Some treatments should not be used during pregnancy and you may need to wait a while after stopping them before trying to conceive. Ask your doctor for advice.

If I become pregnant, will my skin get worse or better?

Most women with psoriasis find their skin improves during pregnancy or there is no change. A minority, between 10 and 20%, find their skin gets worse. Unfortunately, there is no way of predicting how each individual will react. Any improvement is usually fairly short-lived. The signs and symptoms usually recur 6-12 weeks after delivery but are generally no worse than before. Occasionally, the rash of psoriasis may appear for the first time after childbirth, and in some women with psoriasis, symptoms of psoriatic arthritis may develop for the first time after pregnancy.

If needed, what drugs may be used to control my psoriasis during pregnancy?

Understandably, the main concern regarding psoriasis and pregnancy revolves around the treatments needed to control the disease. If you are pregnant or considering getting pregnant it is important to consult your doctor and find out if the treatments you are currently using are safe for you and your baby.
If possible, it is best to try and avoid all drugs during pregnancy, including over the counter remedies, but sometimes some form of treatment is necessary.

Always read if a treatment or product is suitable during pregnancy if in doubt consult your doctor or pharmacist.

Are complementary therapies safe to use during pregnancy?

All treatments should be viewed in the same way as standard therapy during pregnancy with suitable and expert advice.

Birth and Beyond

Will having a C-Section affect my psoriasis?

Yes, it is a possibility, as this will be an operational surgical site where the skin has been damaged and needs to heal, and could cause the Koebner phenomenon.

What is the Koebner phenomenon.

In some people with psoriasis, trauma to the skin including cuts, bruises, burns, bumps, vaccinations, tattoos and other skin conditions can cause a flare-up of psoriasis symptoms either at the site of the injury or elsewhere. This condition is called "Koebner's phenomenon."

Also it may be that the effects of anaesthesia, antibiotics or other medications used may cause some worsening of psoriasis. If you are concerned please talk to your anaesthetist or hospital staff members caring for you so that they can take this into account when making a health plan for you whilst in hospital.

Psoriasis and the nipples

If your nipples become sore which they can do normally during the initial onset of breastfeeding, but you have psoriasis on or around them, don’t worry, psoriasis will not harm your baby, but may be painful for you and you may feel like giving up. Moisturising in thick amounts the nipples and surrounding areas is essential to help the skin and discomfort. Talk to your midwife, she may be able to suggest other positions to breastfeed that can alleviate some of the discomfort.

You may have to try a few products to find the one that your baby is happy with and will let you use!

Are biologic medications safe to take whilst breastfeeding?

Unfortunately, there is no data at the present time to answer this question. This being the case if you can avoid them it is probably best.

Should my health visitor be aware that I have psoriasis/psoriatic arthritis?

Yes. The more information they have about your circumstances the more they can help you or signpost you to others that can support you further.

What drugs may be used to control my psoriasis during breast feeding?

The presence of psoriasis should not influence your decision to breast or bottle feed your baby unless your breasts and nipples are involved. Psoriasis of the breasts and nipples will not harm the suckling baby but may cause you discomfort and therefore make breast feeding a difficult and unpleasant experience which is not how it should be.

Should you decide to breast feed some precautions need to be taken; topical medications should not be used on the nipples and there is a possibility that if you are having to treat large areas of skin some of the drug may be absorbed into your blood stream and then appear in your milk.

Systemic medications, taken by mouth or injection should be avoided during breast feeding if possible because they might be absorbed into the milk and passed to the baby.

If you are thinking of breast feeding, it is best to discuss all this with your doctor before you start.

Will my children get psoriasis?

The exact cause of psoriasis is unknown but it does have an inherited tendency. This means that a number of factors, some inherited and some acquired, are necessary to start psoriasis. An inherited tendency does not mean there is a 100 percent chance that the disease will appear.

About one third of people with psoriasis are able to identify a relative, living or dead, with psoriasis. If one parent has the disease, there is about a 10% chance of developing the disease, and that risk increases to 50% if both parents are affected.

Having said that, two in three people with psoriasis are not aware of any previous family history of the condition.

Always consult a doctor or healthcare advisor