Treatment of Moderate-to-Severe Plaque Psoriasis During Pregnancy or Lactation

This protocol addresses patients with moderate-to-severe plaque psoriasis who are pregnant or breastfeeding — a situation requiring careful selection of systemic therapy to protect both mother and child.

Many standard systemic agents are contraindicated or poorly studied in pregnancy and lactation. Evidence supports that TNF-α inhibitors are safe in pregnancy and during lactation, making this class the cornerstone of biologic management in this population. Agent selection within this class is further guided by placental transfer data.

Management involves a TNF-α inhibitor selected for its safety profile in pregnancy and lactation. Within this class, agents differ in their degree of placental transfer — a key factor driving the preference hierarchy for this population. The full protocol specifies which agent is preferred and what the alternatives are.