What Are The Most Effective Management Strategies For Psoriasis During Pregnancy That Minimize Risks To Maternal And Fetal Health? : A Systematic Review
Keywords:
Psoriasis, Pregnancy, Biologics, Maternal Health, Fetal Health, Certolizumab PegolAbstract
Introduction: Psoriasis, a chronic inflammatory skin disease, affects 2–3% of the global population, including women of childbearing age. Managing psoriasis during pregnancy presents a challenge, balancing maternal disease control with fetal safety, as physiological changes can influence disease severity. Individualized treatment plans are necessary, prioritizing medications with established safety profiles to minimize risks to both mother and fetus while ensuring effective disease control. Methods: This systematic review adhered to the PRISMA 2020 guidelines to ensure methodological rigor and accuracy. Data extraction was performed using a large language model, focusing on study design, population characteristics, management strategies, maternal and fetal health outcomes, and risk of bias. The search strategy employed Boolean MeSH keywords across databases like PubMed, Semantic Scholar, Sagepub, and Google Scholar. Results: Forty studies were included in the systematic review. Biologic therapies, such as TNF inhibitors and ustekinumab, showed acceptable safety profiles with miscarriage rates (8.9–15.3%) and congenital malformation rates (3–4%) comparable to the general population. Certolizumab pegol notably exhibited minimal placental transfer. Methotrexate is contraindicated due to teratogenic effects. Sulfasalazine demonstrated modest efficacy with few serious adverse events. Topical treatments generally lacked robust pregnancy-specific safety data. Discussion: Biologic therapies are effective and generally safe for psoriasis management during pregnancy, with certolizumab pegol being a preferred choice due to minimal placental transfer. Discontinuation of biologics may lead to disease flares, necessitating individualized risk-benefit assessments. Preconception counseling, close monitoring, and shared decision-making are crucial for optimizing outcomes. Conclusion: Effective management of psoriasis during pregnancy balances maternal disease control with fetal health. Biologics offer acceptable safety profiles, with certolizumab pegol being particularly favorable. Methotrexate is contraindicated, and topical treatments require more research for definitive safety recommendations. A multidisciplinary and patient-centered approach, including preconception counseling and close monitoring, is essential to optimize care.
References
A. Blauvelt, and Megan H. Noe. “The Best Psoriasis Medications Emerge.” JAMA Dermatology, 2023.
A. Pinter, L. Green, J. Selmer, M. Praestegaard, L. Gold, and M. Augustin. “A Pooled Analysis of Random- ized, Controlled, Phase 3 Trials Investigating the Efficacy and Safety of a Novel, Fixed Dose Calcipotriene and Betamethasone Dipropionate Cream for the Topical Treatment of Plaque Psoriasis.” Journal of the European Academy of Dermatology and Venereology, 2021.
C. Leonardi, M. Lebwohl, H. Bachelez, K. Gordon, M. Longcore, and K. Papp. “13883 Maintenance of Re- sponse Through 136 Weeks of Long-Term Continuous Risankizumab Treatment: An Analysis of Patients from UltIMMa-1 and UltIMMa-2,” 2020.
C. Mugheddu, L. Atzori, A. Lappi, S. Murgia, and F. Rongioletti. “Biologics Exposure During Pregnancy and Breastfeeding in a Psoriasis Patient.” Dermatologic Therapy, 2019.
Chapman Wei, A. Friedman, and R. Prussick. “Psoriasis Improvement and Satisfaction in Patients Utilizing a Clobetasol Spray and Oral Apremilast Combination Regimen- a Pilot Study.” Journal of American Academy of Dermatology, 2020.
D. Croitoru, S. Brooks, N. Nathanielsz, S. Alsukait, E. Bahashwan, A. Drucker, O. Silverberg, et al. “Fea- tures of Paradoxical Psoriasis and Risk Factors in Inflammatory Bowel Disease: A Systematic Review and Meta‐analysis.” Journal of the European Academy of Dermatology and Venereology, 2023.
E. Pottinger, R. Woolf, L. Exton, A. Burden, C. Nelson-Piercy, and C. Smith. “Exposure to Biological Therapies During Conception and Pregnancy: A Systematic Review,” 2018.
E. Pottinger, R. Woolf, L. Exton, A. Burden, Catherine Nelson-Piercy, and Catherine Smith. “Exposure to Biological Therapies During Conception and Pregnancy: A Systematic Review.” British Journal of Dermatology, 2018.
“Editor's Choice.” British Journal of Dermatology, 2016.
Ennouri Mariem, Bahloul Emna, Sellami Khadija, Marrakchi Slaheddine, Fakhfakh Faiza, Turki Hamida, and Bougacha-Elleuch Noura. “Pustular Psoriasis of Pregnancy: Clinical and Genetic Characteristics in a Series of Eight Patients and Review of the Literature.” Dermatologic Therapy, 2022.
G. Calzado, I. Latour, M. Bullejos, F. Guimerá, C. Vázquez, and J. Nazco. “CP-217 Evaluation of Efficacy, Efficiency and Persistence Rate of Biological Therapy in the Treatment of Moderate to Severe Psoriasis in a Third Level Reference Hospital,” 2016.
Hanh Nguyen, Kawser Ahmed, J. Flint, and I. Giles. “P116 A Systematic Review of the Safety of Non- Tumour Necrosis Factor Inhibitor and Targeted Synthetic Drugs in Rheumatic Disease in Pregnancy,” 2020.
I. Belinchón, M. Velasco, M. Ara-Martín, S. Armesto Alonso, O. Baniandrés Rodríguez, L. Ferrándiz Pulido, M. García-Bustínduy, et al. “Management of Psoriasis During Preconception, Pregnancy, Postpartum, and Breastfeeding: A Consensus Statement.” Actas Dermo-Sifiliográficas, 2020.
J. Carrascosa, I. Belinchón, P. de-la-Cueva, R. Izu, J. Luelmo, and R. Ruiz-Villaverde. “Expert Recommen- dations on Treating Psoriasis in Special Circumstances.” Actas Dermo-Sifiliográficas, 2015.
J. Carrascosa, P. D. L. Cueva, M. Ara, L. Puig, X. Bordas, G. Carretero, L. Ferrándiz, et al. “Methotrexate in Moderate to Severe Psoriasis: Review of the Literature and Expert Recommendations.” Actas Dermo- Sifiliográficas, 2016.
K. Hyrich. “Assessing the Safety of New Drugs During Pregnancy.” British Journal of Dermatology, 2018.
L. Andreoli. “SP0148 DOES PREGNANCY REALLY AMELIORATE DISEASE ACTIVITY OF WOMEN WITH CHRONIC ARTHRITIS? OLD BELIEFS VS NEW PARADIGMS.” Speaker Abstracts, 2019.
L. Gold, B. Ehst, L. Ferris, P. Brown, D. Rubenstein, A. Tallman, and J. Bagel. “34613 Tapinarof Cream 1% Once Daily (QD) for Plaque Psoriasis: Secondary Efficacy Outcomes from a Long-Term Extension (LTE) Trial.” Journal of American Academy of Dermatology, 2022.
L. O'Byrne, S. Alqatari, A. O'SULLIVAN, G. Maher, A. Khashan, G. Murphy, and F. McCarthy. “P-432 Biologic Use During Conception and Pregnancy and Its Impact on Fetal and Maternal Outcomes: Systematic Review and Meta-Analysis.” Human Reproduction, 2022.
Liana Barenbrug, M. Groen, F. Hoentjen, J. van Drongelen, J. Reek, I. Joosten, E. D. De Jong, and R. G. van der Molen. “Pregnancy and Neonatal Outcomes in Women with Immune Mediated Inflammatory Diseases Exposed to Anti-Tumor Necrosis Factor- During Pregnancy: A Systemic Review and Meta- Analysis.” Journal of Autoimmunity, 2021.
M. Alpalhão, Joana Antunes, A. Gouveia, R. Travassos, L. Lopes, Maria Sanches, A. Pinto, et al. “A Randomized Controlled Clinical Trial to Assess the Impact of Motivational Phone Calls on Therapeutic Adherence in Patients Suffering from Psoriasis.” Dermatologic Therapy, 2018.
M. Meroni, E. Generali, G. Guidelli, M. Parodi, M. Cutolo, and Carlo Selmi. “THU0319 Overall Safety of 7-Week Secukinumab Exposure During Pregnancy in Women with Psoriatic Arthritis,” 2018.
M. Noe, M. Wan, D. Shin, A. Armstrong, K. Duffin, Z. C. Chiesa Fuxench, R. Kalb, et al. “Patient-Reported Outcomes of Adalimumab, Phototherapy, and Placebo in the Vascular Inflammation in Psoriasis Trial: A Randomized Controlled Study.” Journal of American Academy of Dermatology, 2019.
M. S. Ferreira, Ricardo Machado Xavier, E. Abbeg, Otávio Ritter Silveira Martins, F. A. Menegat, C. Kohem, A. Gasparin, et al. “THU0319 Overall Safety of 7-Week Secukinumab Exposure During Pregnancy in Women with Psoriatic Arthritis.” THURSDAY, 14 JUNE 2018:, 2018.
Maria-Angeles Ferrer-Alcala, M. Sánchez-Díaz, S. Arias-Santiago, and A. Molina‐Leyva. “Impact of Psoriasis and Hidradenitis Suppurativa in Pregnancy, a Systematic Review.” Journal of Clinical Medicine, 2021.
“Meta-Analysis of Associations Between Psoriasis and Adverse Pregnancy Outcomes.” Chinese Journal of Dermatology, 2020.
Mia Noergaard, Stine S. Clausen, and J. Andersen. “Paternal Acitretin Exposure and the Risk of Miscarriage and Major Congenital Malformations: A Nationwide Register-Based Cohort Study.” Journal of American Academy of Dermatology, 2020.
N. Ghalandari, R. Dolhain, J. Hazes, E. Puijenbroek, M. Kapur, and Hubertina Johanna Maria Josephina Crijns. “AB0378 AN UPDATE AND SYSTEMATIC REVIEW ON USING BIOLOGICALS DURING PREGNANCY IN INFLAMMATORY AUTOIMMUNE DISEASES.” Abstracts Accepted for Publication, 2019.
N. Ghalandari, R. Dolhain, J. Hazes, E. van Puijenbroek, M. Kapur, and H. Crijns. “Intrauterine Exposure to Biologics in Inflammatory Autoimmune Diseases: A Systematic Review.” Drugs, 2020.
N. Hilhorst, E. Deprez, N. Pauwels, L. Grine, J. Lambert, and I. Hoorens. “Patient-Relevant Outcomes in Psoriasis: A Systematic Review.” JAMA Dermatology, 2022.
N. Tsao, N. Rebić, L. Lynd, and M. D. de Vera. “Maternal and Neonatal Outcomes Associated with Biologic Exposure Before and During Pregnancy in Women with Inflammatory Systemic Diseases: A Systematic Review and Meta-Analysis of Observational Studies.” Rheumatology, 2020.
R. Bobotsis, Wayne Gulliver, K. Monaghan, C. Lynde, and P. Fleming. “Psoriasis and Adverse Pregnancy Outcomes: A Systematic Review of Observational Studies.” British Journal of Dermatology, 2016.
R. Guelimi, A. Chaimani, Rosa Parisi, L. Penso, C. Hughes, S. Afach, Émilie Sbidian, and L. Le Cleach. “Serious Adverse Events Associated with Systemic Treatments for Psoriasis: A Network Meta-Analysis of Observational Studies and Randomized Controlled Trials.” Cochrane Database of Systematic Reviews, 2024.
S. Rahmati, Hossein Moameri, Neda Malek Mohammadi, Mojtaba Norouzi, N. Ghalekhani, Amin Beigzadeh, N. Changizi, and H. Sharifi. “Impact of Maternal Psoriasis on Adverse Maternal and Neonatal Outcomes: A Systematic Review and Meta-Analysis.” BMC Pregnancy and Childbirth, 2023.
S. Sood, A. Bagit, K. Maliyar, M. Sachdeva, D. Croitoru, and J. Yeung. “Use of Sulfasalazine for Psoriasis: An Evidence-Based Review.” JAAD International, 2024.
V. Sánchez-García, R. Hernández‐Quiles, E. de‐Miguel‐Balsa, Á. Giménez‐Richarte, J. Ramos-Rincon, and I. Belinchón-Romero. “Exposure to Biologic Therapy Before and During Pregnancy in Patients with Psoriasis: Systematic Review and Meta‐analysis.” Journal of the European Academy of Dermatology and Venereology, 2023.
W. Xie, Hong Huang, L. Ji, and Zhuoli Zhang. “Maternal and Neonatal Outcomes in Pregnant Women with Psoriasis and Psoriatic Arthritis: A Systematic Review and Meta-Analysis.” Rheumatology, 2021.
Wuxiang Xie, Hong Huang, and Z. Zhang. “POS0148 MATERNAL AND NEONATAL OUTCOMES IN PREGNANT WOMEN WITH PSORIASIS AND PSORIATIC ARTHRITIS: A SYSTEMATIC RE- VIEW AND META-ANALYSIS,” 2021.
X. Mariette, F. Förger, Bincy T. Abraham, A. Flynn, A. Moltó, R. Flipo, A. V. van Tubergen, et al. “Lack of Placental Transfer of Certolizumab Pegol During Pregnancy: Results from CRIB, a Prospective, Postmarketing, Pharmacokinetic Study.” Annals of the Rheumatic Diseases, 2017.
Y. Kaplan, J. Ozsarfati, F. Etwel, C. Nickel, I. Nulman, and G. Koren. “Pregnancy Outcomes Following First‐trimester Exposure to Topical Retinoids: A Systematic Review and Meta‐analysis.” British Journal of Dermatology, 2015.
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