How might the disease and treatment affect your pregnancy? And what is the likelihood of passing on PsA to your child? Here are seven questions that might be going through your mind, along with expert answers to calm some of your fears. Read on, and then talk with your doctor about your concerns and your overall health.
1. Is It Harder to Get Pregnant With PsA?
According to R. Sonia Batra, MD, MPH, a board-certified dermatologist in Santa Monica, California, and a cohost of the TV talk show The Doctors, there is no evidence to suggest that having psoriatic arthritis will affect your fertility. The stress of worrying about flare-ups, however, can make it more difficult to become pregnant. “It’s best to have symptoms of psoriatic arthritis well-controlled before you try to conceive,” says Dr. Batra. “Some medications for treating psoriatic arthritis or psoriasis, such as methotrexate or retinoids, can cause miscarriage and birth defects, so it is important to ask your doctor if changes need to be made to your treatment plan in advance of pregnancy.”
2. Should I Undergo Genetic Testing?
“The decision to undergo genetic testing is very personal, but there are known gene variants that increase the risk of both psoriatic arthritis and psoriasis,” says Batra. “Whether a person with a susceptibility gene develops psoriatic arthritis is determined by a complex interplay of the gene environment and the immune system.” Batra stresses that it’s important to remember that many women with the disease have healthy babies.
3. Will I Pass on PsA to My Child?
The exact cause of PsA is unclear, though genetics likely play a role. According to Anthony Scialli, MD, an obstetrician-gynecologist in Washington, DC, it is not possible to predict what proportion of children of people with PsA will get the disease. “The highest risk seems to be associated with a gene called PSORS1, which increases the risk about sixfold,” says Dr. Scialli, who is an expert member of the Organization of Teratology Information Specialists (OTIS), a professional nonprofit that provides the service MotherToBaby. “If the general population risk is about 2 percent, inheriting an abnormal PSORS1 gene would increase the risk to 12 percent.”
4. Can My PsA Medications Harm the Fetus?
It depends on which psoriatic arthritis medication you’re taking, says Scialli. “In the past, a mainstay of treatment was methotrexate, which is not used during pregnancy because it can increase the risk of birth defects.” More recent treatments, called biologics, disable parts of the immune system. Some of them are so new that we have no information on use during human pregnancy, according to Scialli. Some of these drugs have been used in a number of pregnancies without an increase in birth defects. “Possible interference with the immune function of the child after birth is a theoretical concern,” says Scialli. “Some pediatricians recommend avoiding live virus vaccines during the child’s first year of life.”
5. Will It Take Me Longer to Get Pregnant?
“In general, women with inflammatory diseases may have more trouble getting pregnant,” says Scialli. “Getting the inflammation under control prior to pregnancy is recommended.”
6. Will PsA Medications Affect a Male Partner’s Fertility?
Research has shown that sulfasalazine therapy in men may decrease sperm quality. “But this effect is reversible,” says Scialli. “It may be preferable for a man with psoriatic arthritis to use 5-aminosalicylic acid (mesalazine), one of the metabolites of sulfasalazine.” But there is some evidence that mesalazine may also lead to poor semen quality. “Just in case, a man can consider having some semen samples frozen for future use in the event the medication is associated with poor sperm quality,” says Scialli.
7. How Will My Pregnancy Affect My PsA?
According to Norbert Gleicher, MD, a fertility expert and the founder of the Center for Human Reproduction in New York City, autoimmunity and pregnancy have a very complex relationship. Women with autoimmunity are at increased risk at the beginning and the end of pregnancy. “At the beginning, the risk is mostly miscarriages but also, at times, a harder time for embryos to implant,” says Dr. Gleicher. “Toward the end of pregnancy, all autoimmune diseases are associated with a higher risk for premature labor or delivery and pregnancy complications, like preeclampsia.” Most importantly, Gleicher explains, autoimmune diseases tend to flare after the child is delivered and for up to five months postpartum. Autoimmune diseases often also present for the first time in that time period in women. Interestingly, the time between these two risk periods in pregnancy is usually “quiet” and autoimmune diseases typically improve.
