Biologics exposure during pregnancy and breastfeeding in a psoriasis patient

Biologic agents have revolutionized the treatment of psoriasis, and the increasing use of these agents in women of childbearing age raises questions regarding pregnancy safety. We report a case of a woman affected with severe psoriasis, who underwent three pregnancies while exposed to biologic agents. Although immediately dismissed at first pregnancy awareness, first-trimester exposure occurred, and the course of the pregnancies was carefully monitored. The patient was under adalimumab treatment during her first pregnancy and ustekinumab at her second and third gestation. She had a premature birth at 35 weeks during the first two pregnancies and at 36 weeks during her last pregnancy. All babies were born healthy without congenital anomalies. Furthermore, due to the rapid worsening of her psoriasis, biologics treatment was reintroduced immediately after breastfeeding in the first two occasions, but immediately after delivery in the last pregnancy, with the explicit consent of the patients. There are few data available on biologics treatment safety during pregnancy and breastfeeding, especially regarding ustekinumab. We report our positive experience with the aim of increasing case notifications, facilitate meta-analysis, and eventual consensus recommendations regarding the use of biologics in special population.