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Navigating Stelara and Pregnancy – Stelara (ustekinumab) is a monoclonal antibody used to treat moderate to severe plaque psoriasis and psoriatic arthritis.
It works by blocking interleukin-12 and interleukin-23, two proteins that lead to inflammation and overactive immune responses in these diseases.
Stelara is a relatively new treatment option that has shown great efficacy for many patients. However, its safety during pregnancy has not been extensively studied.
This leaves many women with chronic inflammatory diseases facing difficult choices when they want to start or expand their families.
Balancing health and safety during pregnancy involves understanding the risks of both staying on and stopping complex medications like Stelara.
It also requires open and non-judgmental conversations with healthcare providers about an individual’s priorities and values during this important life stage.
Understanding Stelara and Pregnancy Risks
The data on Stelara use during pregnancy is limited but seems largely reassuring so far. A small study of pregnancy outcomes from clinical trials did not find higher rates of complications like miscarriage, congenital disabilities, preterm birth, or low birth weight in the Stelara group compared to disease-matched controls.
However, the sample size was very small. Larger registries are still accumulating data. The FDA has labeled Stelara as Pregnancy Category B, meaning animal studies show no risk, but well-controlled human studies are lacking. They advise weighing the benefits and risks carefully with a provider during pregnancy.
Research shows that active inflammatory disease itself can pose some risks to pregnancy. Women with uncontrolled psoriasis and psoriatic arthritis tend to have higher rates of complications like premature delivery, low birth weight infants, and cesarean sections compared to healthy mothers.
Flare-ups may also make it difficult to care for a newborn while recovering from childbirth. Managing disease activity is crucial during this vulnerable time. (Navigating Stelara and Pregnancy)
The lack of certainty around Stelara and pregnancy leaves many mothers facing difficult tradeoffs. Stopping a highly effective medication could lead to uncontrolled symptoms and disease progression. This poses tangible physical and mental health risks.
However, continuing an antidepressant drug brings undefined risks, too. There are no guarantees when it comes to medication safety in pregnancy. Each choice carries pros, cons, and uncertainties.
Doctors vary in their approach as there are no right answers. Some advise stopping Stelara several months before trying to conceive, while others are comfortable with continuing through pregnancy and breastfeeding if needed for the mom’s health.
The key is finding an understanding provider who can thoughtfully assess the tradeoffs given a woman’s unique health history, risks, values, and priorities. They should present both the pros and cons of all options instead of making unilateral and rigid recommendations.
Finding clarity and comfort often requires consulting both dermatology and maternal-fetal medicine (high-risk obstetrics) doctors to integrate all perspectives. Support groups can also connect mothers who have faced similar dilemmas.
Fathers and partners must help navigate these decisions, too. Planning for pregnancy and parenting is a team effort built on trust, empathy, and shared responsibility for family health. (Navigating Stelara and Pregnancy)
Making the best choice around treatment through fertility, pregnancy, childbirth, and beyond necessitates very open communication with care providers. However, research shows many mothers struggle to find a judgemental-free space for these vulnerable conversations.
Women report feeling shamed when wanting to balance family plans with chronic health needs instead of focusing solely on minimizing any risks to the fetus. The notion of stopping all medications while pregnant gets positioned as an obligation rather than an option.
In reality, pregnancy means managing two patients (mother and child) with two sets of legitimate health considerations. Difficult risk-benefit analyses don’t have moral right or wrong answers.
That’s why collaborative decision-making that gives equal weight to mom’s well-being is so essential. Shared priorities, values, pros, and cons can guide personalized treatment plans during the transition to parenthood. (Navigating Stelara and Pregnancy)
Some things that may shape specific decisions around Stelara include:
- Disease severity and impact on quality of life
- Prior medication response and alternatives
- Plans around breastfeeding after birth
- Access to care for disease management
- Support systems to help parents manage symptoms
- Risk tolerance and worry regarding fetal development
- Reproductive history and other pregnancy risk factors
Of course, an expecting mother can choose full caution by stopping treatment despite personal health implications. The key is arriving at the choice together with her providers based on open conversations about all contributing issues. (Navigating Stelara and Pregnancy)
Balancing Act
Navigating chronic inflammatory disease and building a family both require tremendous strength and resilience. The uncertainty around medication safety in pregnancy simply stacks onto existing health challenges. But with compassion and support, new mothers can find solutions tailored to their needs.
This balancing act starts with finding a care team willing to understand a woman’s priorities holistically while gently providing guidance.
It may involve coordinating care between specialties to integrate all vantage points. Support groups can also connect patients facing similar complexity.
While research on Stelara’s safety profile continues to evolve, the decision ultimately lies with each patient. Treatment choices factor in disease impacts, medication response, care access, risk tolerance, and so much more.
Through open conversations and shared decision-making, women can find the path that sustains their family’s health, however, they define it.
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