There are many considerations that can go into making treatment decisions for psoriasis and psoriatic arthritis, including personal attributes like age and medical history, social factors like affordability of and access to treatments as well as clinical considerations around potential side effects.
If you are a woman who is considering getting pregnant, is currently pregnant or is breastfeeding, or considering it, these are all considerations that need to be taken into account when contemplating treatment options.
A recent survey found that only 7% of family planning conversations between women and their specialists are initiated by health care providers. The vast majority are started by patients themselves, so if you feel like this is a conversation you need to have with your primary health care provider, or dermatologist, you’re not alone!
The next section of this guide, Pregnancy and Family Planning, will provide some tools for talking with your doctor about unique issues for women, particularly if there is a possibility of getting pregnant.
Pregnancy and Family Planning
Psoriasis and psoriatic arthritis can affect family planning decisions, including everything from treatment decisions to lifestyle choices to preparing for the birth of a baby. Yet, one study found that 33% of patients with psoriasis and/or psoriatic arthritis delayed informing their specialist about their pregnancy and 20% did not tell them at all.
If you are considering treatment for psoriasis and psoriatic arthritis and are thinking about pregnancy and breastfeeding, researching treatment options is a good way to start, including talking with your doctor as early on as possible about your personal goals and your options.
If you are on treatment for psoriasis or psoriatic arthritis and are thinking about pregnancy and/or breast-feeding, consider the following ideas and questions for engaging your health care team.
Let your doctor and health care team (e.g., dermatologist, rheumatologist, nurse practitioner) know if you’re thinking about planning a family now, or in the future.
Inform your doctor about any other medications you are taking for any other health conditions.
Let your obstetrician or midwife know that you have psoriasis and/or psoriatic arthritis and inform them of any treatments you’re on. It can also be beneficial to share contact information across your health care providers to have them communicate with one another if needed.
Discuss specific symptoms that may affect your pregnancy or delivery. For example, talk to your health care team, including your obstetrician or midwife, about any pain that you experience (e.g., joint pain) to develop strategies for managing pain during labour and delivery. If you have genital psoriasis, let your health care providers know so they can be considerate of this throughout your pregnancy, delivery and post-delivery.
Discuss a delivery plan in advance, and talk to your healthcare team and your child’s pediatrician about vaccinations for both you and your baby.
Connect with your doctor and health care team as needed throughout your pregnancy. Discuss any concerns or questions you have with them while expecting.
Talk to your doctor and health care team about what you can expect after pregnancy (e.g., flare ups, treatment options post-delivery) and what you can do if they occur.
Talk to your doctor about your treatment plan post-delivery.
Delivery and Post-pregnancy
Keep your health care team informed about your psoriasis and/or psoriatic arthritis after delivery, including any new symptoms or concerns.
If you are breastfeeding, talk with your health care provider and your baby’s pediatrician about safe application of any topical treatments you are using including how long you need to let medications absorb into your skin before it is safe for your baby to touch without needing a barrier.