Table 1.

Systemic treatment options for moderate-to-severe psoriasis during pregnancy.

Drug	FDA Pregnancy Risk Categories *	Observations
Cyclosporine	C	Preferred Conventional
Metotrexate	X	Contraindicated (3 months drug-free interval before conception)
Acitretin	X	Contraindicated (3 years drug-free interval before conception)
Dimethyl-fumarate	C	Contraindicated
Apremilast	C	Contraindicated
Anti-TNF-alpha	B	Certolizumab Pegol: preferred biologic
Anti IL-12/23	B	Stopping in the second and third trimesters
Anti IL-17	B (Secukinumab) N/A (Ixekizumab; Brodalumab)	Stopping in the second and third trimesters Limited available data on use in pregnant women are insufficient to inform a drug-associated risk of adverse developmental outcomes
Anti IL-23	N/A	Limited available data on use in pregnant women are insufficient to inform a drug-associated risk of adverse developmental outcomes

FDA: Food and Drug Administration; TNF: Tumour Necrosis Factor; IL: Interleukin; N/A: Not Available; * FDA Category of Drug Evidence: A: Adequate, well-controlled studies in pregnant women do not show any risk to the fetus in the first trimester; B: Animal studies did not demonstrate risk to the fetus; no well-controlled studies in humans exist; or animal studies demonstrated risk, but well-controlled studies in pregnant women do not demonstrate adverse effects on the fetus; C: Animal studies demonstrate risk to the fetus (this category also applies to drugs for which no animal or well-controlled studies in humans exist); D: There is evidence of risk to the fetus with these drugs, but their benefits may outweigh risks; X: There is positive evidence of risk that outweighs any possible benefit.