CHART 4.

Biological drugs used in psoriasis and psoriatic arthritis and their infl uence during pregnancy

Medication	Adverse events in pregnancy	Adverse events in animals	Conclusion
Biological
Adalimumab	Isolated cases of trisomy 18, megacolon, ventricular septal defects, hemangioma, Wolfe-Parkinson-White syndrome, neurofibromatosis, VACTER syndrome, non-descended testicle, microcephaly, congenital hip dysplasia, hydronephrosis.	Fetal death and structural defects	Limited data available, if administration is justified by the severity of maternal illness, discontinue it until 30th week
Alefacept	No available data	No available data	Contraindicated due to the lack of available data
Etanercept	Isolated cases of VATER syndrome and trisomy 18 and 21, pyloric stenosis, hip dysplasia, heart hypoplasia, inguinal hernia, congenital megacolon, ventricular septal defects, transverse stomach, hypospadias, congenital hypothyroidism	Fetal death and structural defects	Limited data available, if administration is justified by the severity of maternal illness, discontinue it until 30th week
Infliximab	Isolated cases of congenital malformations (tetralogy of Fallot, intestinal malrotation, ventricular septal defects, anencephaly, polydactyly, kidney agenesis), intracerebral and intrapulmonary bleeding, respiratory failure, developmental delay, death from unknown causes Disseminated fatal infection after BCG vaccination	Fetal death and structural defects	Limited data available, if administration is justified by the severity of maternal illness, discontinue it until 30th week
Ustekinumab	Miscarriages	Absence of adverse events regarding mortality, mental, morphological and immunological development One study demonstrated virilizing effect in female monkeys	Contraindicated due to limited available data
Certolizumab	Absence of congenital malformations	No available data	Not yet approved for use in psoriasis