Psoriasis and Psoriatic Arthritis in Pregnancy: Current Evidence and Clinical Considerations

Psoriasis and psoriatic arthritis (PsA) are chronic, immune-mediated inflammatory diseases that commonly affect individuals of reproductive age, presenting unique challenges relating to fertility, pregnancy, lactation, and long-term reproductive health. This narrative review summarizes the current evidence on the relationship between psoriatic diseases and pregnancy, focusing particularly on disease activity, fertility, obstetric outcomes, hereditary risk, the psychosocial impact, and treatment options throughout the reproductive journey. The available evidence indicates that psoriasis and PsA can impact reproductive health and fertility, as well as pregnancy outcomes, particularly in individuals with active or severe disease. Chronic systemic inflammation and associated comorbidities likely play an important role in these associations. While pregnancy-related immunological adaptations may improve disease activity in some women, flare-ups remain common during the postpartum period. The management of psoriatic disease during pregnancy has undergone a substantial paradigm shift. Contemporary evidence increasingly supports maintaining adequate disease control throughout the reproductive period with therapies with an established safety profile. This review highlights the evolving understanding of psoriasis and PsA as systemic diseases that extend beyond dermatological and rheumatological manifestations and may influence reproductive health at multiple levels. Future research should focus on the long-term safety of newer targeted therapies, the impact of paternal exposure, patient-reported reproductive outcomes, and developing evidence-based, multidisciplinary care pathways for women with psoriatic disease during pregnancy and the postpartum period.