From the Guidelines
Methotrexate, acitretin, and tazarotene are contraindicated for use during pregnancy due to their potential to cause birth defects and other serious health issues. The use of methotrexate during pregnancy is associated with an increased risk of miscarriage and severe birth defects, and it should be discontinued at least 3 months before conception 1. Acitretin, a systemic retinoid, is also contraindicated during pregnancy and for at least 3 years before conception due to its severe teratogenic effects 1. Tazarotene, a topical retinoid, is contraindicated due to potential birth defects.
Some key points to consider when managing psoriasis during pregnancy include:
- Methotrexate should be avoided during pregnancy and for at least 3 months before conception due to its teratogenic effects 1
- Acitretin should be avoided during pregnancy and for at least 3 years before conception due to its severe teratogenic effects 1
- Tazarotene should be avoided during pregnancy due to potential birth defects
- Coal tar is likely to be safe for use during pregnancy, but its use should be limited to brief periods of time 1
- Biologics have varying safety profiles, and their use during pregnancy should be carefully considered on a case-by-case basis
In terms of safer treatment options for pregnant women with psoriasis, low to moderate potency topical corticosteroids, UVB phototherapy, and in some cases cyclosporine may be considered, although cyclosporine carries risks of hypertension and renal dysfunction. Any psoriasis treatment during pregnancy should be carefully discussed with both a dermatologist and obstetrician to weigh potential benefits against risks.
From the FDA Drug Label
Methotrexate can cause fetal death or teratogenic effects when administered to a pregnant woman. Methotrexate is contraindicated in pregnant women with psoriasis or rheumatoid arthritis and should be used in the treatment of neoplastic diseases only when the potential benefit outweighs the risk to the fetus Pregnancy Teratogenic Effects, Pregnancy Category X Psoriasis and rheumatoid arthritis: Methotrexate is in Pregnancy Category X (See CONTRAINDICATIONS).
The treatments for psoriasis that are contraindicated for use during pregnancy are:
- d. methotrexate 2 Note: The provided drug labels only contain information about methotrexate, therefore, no conclusion can be drawn about the other options.
From the Research
Psoriasis Treatments Contraindicated During Pregnancy
The following psoriasis treatments are contraindicated for use during pregnancy:
- Methotrexate: due to its teratogenic effects 3, 4
- Acitretin: as it is a known teratogen and mutagen 3, 4
- Tazarotene: because of unclear risks of teratogenicity 5
- Infliximab: as biologics are not currently recommended in pregnant psoriasis patients, although the risk may be relatively low 4
Additional Considerations
Other treatments, such as coal tar, may not have clear evidence regarding their safety during pregnancy, but are not explicitly contraindicated in the provided studies. Topical corticosteroids are considered safe during pregnancy, but effective only for localized forms of psoriasis 6, 5. Ultraviolet B phototherapy is preferred for moderate-to-severe psoriasis 5. Biologics may be considered in certain cases, but their use should be carefully evaluated due to limited safety data 7, 4.