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Biologics and Pregnancy: 5 Facts

Medically reviewed by Haley Naik, M.D.
Written by Joan Grossman
Posted on July 9, 2024

Biologic medications are made from living organisms and can effectively control hidradenitis suppurativa (HS) symptoms and disease progression. Many myHSteam members wonder if you can be on these medications during pregnancy: “Anyone have insight into how HS was during pregnancy? Can you be on a biologic while pregnant?”

Dr. Haley Naik, an associate professor at the University of California, San Francisco (UCSF), discussed pregnancy and biologic therapy for individuals with HS in an interview with myHSteam. Dr. Naik is a leading researcher in the field of immune-mediated skin conditions, with a focus on HS. She established the UCSF Hidradenitis Suppurativa Clinic.

“One of the responsibilities that we have as health care providers is to help our patients understand the benefits and potential risks of medications — and particularly biologics — in the setting of pregnancy,” Dr. Naik said. She aims to help people make informed decisions about their HS treatment during pregnancy.

HS is an inflammatory skin disease that causes painful lesions (sores and bumps) in areas of the body with many sweat glands, such as the armpits, groin, under the breasts, and buttocks. HS is believed to be an immune-mediated disease in which the immune system is overactive and attacks healthy tissue, causing inflammation. Biologic medications are sometimes used to treat HS.

If you’re considering pregnancy and are currently treating your HS with biologics, here are some facts to discuss in detail with your doctors.

1. You Can Discuss Treatment Options Before Pregnancy

Dr. Naik urges people with HS who are considering pregnancy to talk to their dermatologist and gynecologist or obstetrician well ahead of time about treatment options during pregnancy. Research has shown that pregnancy affects HS differently in individuals. In about 24 percent of cases, HS improves with pregnancy, but in 20 percent of pregnancies, HS gets worse.

“Those initial visits can help health care providers better understand the patient’s goals in terms of managing their HS and concurrently managing their pregnancy. This visit is an opportunity to learn about safe treatment options during pregnancy and breastfeeding, including topical and systemic antibiotics and biologics, and sometimes procedural interventions,” Dr. Naik explained. “A lot of the questions that come up in that setting, of course, are ‘How effective are these medications, and are they safe not only for me but for the baby that I am carrying?’”

Dr. Naik said that people often go to their doctors with HS symptoms after they are already pregnant, sometimes in their second or third trimester. However, it can be beneficial for these conversations to happen before pregnancy so that, along with their doctors, people can plan and prepare.

2. If You Manage HS Before Pregnancy, It Can Lead to a Smoother Experience

Working with your doctor to get your HS under control before trying to get pregnant can help set you up for an easier time during your pregnancy. “Pregnancy is associated with a lot of changes, including fatigue and weight gain,” said Dr. Naik. “We believe that patients are setting themselves up best to grow another human being when their body is at its most comfortable and least inflamed.”

Although studies are limited, there is some evidence that compared to the general population, people with HS have an increased risk of complications, such as high blood pressure, preeclampsia, gestational diabetes, and miscarriage. Controlling HS in pregnant women is associated with better pregnancy outcomes.

Dr. Naik explained, “If you are inflamed and your body is trying to heal its HS lesions and wounds, that is energy that is not spent growing and developing a baby. From this perspective, it is ideal for an individual’s HS to be as controlled as possible throughout pregnancy.”

It’s also important to control other comorbidities (related conditions) that can occur with HS, such as inflammatory bowel disease (Crohn’s disease or ulcerative colitis) or metabolic syndrome — a group of conditions that increase the risk of heart disease, stroke, and diabetes.

3. Biologics Are Considered Safe for Pregnancy and Breastfeeding

In the past, there was concern that using biologics during pregnancy might suppress infants’ immune systems and put them at a higher risk of infection. However, a 2022 review of more than 30 studies of biologic use during pregnancy found that using biologics did not pose a risk to the fetus.

Another study showed that using biologics during pregnancy among people with psoriasis — another inflammatory skin condition — did not increase the risk of miscarriage or congenital anomalies (birth defects).

“We consider biologics to be inordinately safe not only in the context of pregnancy but also in the context of breastfeeding,” Dr. Naik said.

Two biologic drugs have been approved by the U.S. Food and Drug Administration (FDA) for HS — adalimumab (Humira) and secukinumab (Cosentyx). Infliximab (Remicade) is a biologic drug that is sometimes prescribed off-label for HS.

“We have decades of data using adalimumab in the context of pregnancy and a whole host of inflammatory diseases that show that this medication can be safely used in pregnancy. Secukinumab is a much newer medication, but we also have data to support that this is a medication that can be safely used in the context of pregnancy,” Dr. Naik explained.

“I want to help my HS patients carry their baby to term and also be able to breastfeed if they wish to. Helping my patients control their HS is an important step toward meeting these goals, and biologic medications are a tool that can support those goals,” she added.

Because each case of HS is unique, if you’re planning a pregnancy or already pregnant, it’s important to discuss biologics and all of your treatment plans with your doctors.

4. You Should Talk to Your Pediatrician if You Use Biologics While Pregnant

One risk associated with using biologics during pregnancy is that many of these drugs can pass through the placenta to the baby during the third trimester. The placenta is an organ that develops during pregnancy and is attached to the umbilical cord to provide nutrients and oxygen to the fetus.

“We know that many biologics can cross the placental barrier in the third trimester,” Dr. Naik said. Dr. Naik explained that if a baby is exposed to biologics in the womb, the potential risks can be limited. “We have data that supports [that] this exposure to biologics does not contribute to lower birth weight or adverse pregnancy outcomes,” she said.

Breastfeeding while on a biologic can also cause a baby to have some exposure to the drug through breast milk, so people need to take precautions. Dr. Naik emphasized the importance of informing your pediatrician if you’re taking a biologic drug while pregnant or breastfeeding. This allows the pediatrician to discuss the potential risks and benefits of administering live vaccines [made with a weakened virus] to your baby. “The primary live vaccines to consider in that case are the rotavirus vaccine and the measles, mumps, and rubella [MMR] vaccine.”

5. The More You Know About Pregnancy and HS, the Better You Can Improve Your Care

One challenge for people with HS is finding doctors who understand the disease. Dr. Naik described an “uphill task” to ensure “health care providers are knowledgeable about HS in general and HS in the management of pregnancy.” She believes it’s important for people with HS to take advantage of resources that can help them better understand HS. It’s essential to advocate for yourself to make sure your doctors understand your condition and treatment goals so they can provide the care you need.

Dr. Naik recommended the HS Foundation as a good source of information for people living with HS: “Patients can educate themselves and point providers who they see — and maybe have to see because of their insurance coverage or their location — to information that will help them feel comfortable giving patients the care they need.” She added that the HS Foundation can also help connect your doctor to HS specialists nationwide.

Dr. Naik also said it’s important to have your doctors talk to each other so that care is coordinated between your dermatologist, OB-GYN, primary care doctor, and pediatrician if you’re taking biologics and have a newborn baby.

“Another option is to seek care with a high-risk OB-GYN, who will be familiar with the safety profile of biologics in the management of a whole host of diseases, including HS,” Dr. Naik emphasized.

In her research, Dr. Naik has found that many people don’t believe their HS can be managed while they are pregnant. But that isn’t the case: “If patients could walk away from this conversation with one message, what I’d want them to know is that there are treatment options for HS that are safe to use during pregnancy and breastfeeding. These options can help them enjoy the experiences of pregnancy and breastfeeding without worrying about their HS.”

Find Your Team

On my myHSteam, the social network for people with hidradenitis suppurativa and their loved ones, more than 42,000 members come together to ask questions, give advice, and share their stories with others who understand life with HS.

If you’ve been pregnant and have HS, how did you manage your symptoms? Did you plan your pregnancy ahead of time with your doctors? Share your experience in the comments below, or start a conversation by posting on your Activities page.

    Posted on July 9, 2024
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    Haley Naik, M.D. is a dermatologist affiliated with University of California San Francisco (UCSF) Health. Learn more about her here.
    Joan Grossman is a freelance writer, filmmaker, and consultant based in Brooklyn, NY. Learn more about her here.

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