Is it safe to use immunosuppressants during parenthood or pregnancy? 

Navigating parenthood or pregnancy while managing a chronic skin condition like eczema or psoriasis requires careful planning. Immunosuppressants vary widely in their safety profiles; some are strictly prohibited during conception and pregnancy, while others are considered compatible and even necessary to maintain the mother’s health. In the UK, the British Society for Rheumatology (BSR) and the British Association of Dermatologists (BAD) provide updated safety guidelines for 2026 to help families make informed decisions. The goal is always a “healthy mother, healthy baby,” balancing the risk of the medication against the risk of an uncontrolled inflammatory flare-up. 

What We’ll Discuss in This Article 

• The strict contraindications for Methotrexate and Acitretin. 

• Immunosuppressants considered safe for pregnancy (e.g., Ciclosporin, Azathioprine). 

• The safety of Biological therapies and their impact on infant vaccinations. 

• Guidelines for fathers planning a family while on systemic treatment. 

• The safety of breastfeeding while taking various immunosuppressants. 

• The importance of a pre-conception medication review. 

1. Medications that are NOT safe 

Certain systemic treatments used for psoriasis and eczema are known as teratogens, meaning they can cause significant birth defects or miscarriage. 

• Methotrexate: This is strictly contraindicated during pregnancy. Women must stop methotrexate at least 1 to 6 months (depending on specific NHS trust guidance) before attempting to conceive. 

• Acitretin (Oral Retinoid): This is one of the most restrictive medications. Because it stays in the body for a very long time, women are advised not to conceive for three years after their last dose. 

• JAK Inhibitors (e.g., Abrocitinib, Upadacitinib): As of 2026, these newer “small molecule” drugs are generally not recommended during pregnancy due to a lack of long-term human safety data. 

2. Immunosuppressants considered safe (Compatible) 

If your skin condition is severe, your dermatologist may switch you to or maintain you on a “compatible” medication that has a proven safety record during pregnancy. 

• Ciclosporin: Frequently used as a “rescue” treatment for severe flares during pregnancy. It is considered compatible, though it requires close monitoring of the mother’s blood pressure and kidney function. 

• Azathioprine: Considered safe to continue during pregnancy at doses less than 2mg/kg per day. It is often preferred for women with severe atopic eczema. 

• Corticosteroids (e.g., Prednisolone): Low doses may be used to manage acute flares, though long-term high doses are avoided due to the risk of low birth weight. 

3. Biological therapies and pregnancy 

One of the biggest shifts in dermatology over the last decade has been the increasing use of biologics during pregnancy. 

• Certolizumab Pegol (Cimzia): This is often the preferred biologic for pregnancy because its structure prevents it from crossing the placenta in significant amounts. It is considered safe to use throughout all three trimesters. 

• Anti-TNF Alphas (e.g., Adalimumab, Etanercept): These are generally considered safe in the first and second trimesters. Many UK consultants advise stopping them at week 20-28 to ensure the baby is not born with high levels of the drug. 

• Infant Vaccination Warning: If a mother takes a biologic during the third trimester, the baby must not receive “live” vaccines (such as the BCG or Rotavirus vaccine) for the first 6 months of life, as their immune system may be temporarily dampened. 

4. Guidance for Fathers (Paternal Exposure) 

The rules for men are often different than for women. 

• Methotrexate: Modern 2026 guidelines (including those from BSR) state that men can safely continue methotrexate while trying to conceive with their partner, as there is no evidence of increased risk to the fetus from paternal use. 

• Most Biologics and Systemics: The majority of other immunosuppressants (Ciclosporin, Azathioprine, Biologics) are considered compatible with fatherhood and do not affect sperm quality or fetal health. 

5. Breastfeeding and Immunosuppressants 

The decision to breastfeed while on medication is based on how much of the drug passes into the breast milk. 

• Compatible: Azathioprine, Ciclosporin, and most Biological therapies are considered compatible with breastfeeding, as only tiny amounts enter the milk and are usually broken down in the baby’s stomach. 

• Avoid: Methotrexate and Acitretin should still be avoided during breastfeeding. 

Conclusion 

Parenthood with eczema or psoriasis is entirely possible, but it requires a “safety-first” approach to medication. While some drugs like methotrexate are strictly off-limits, others like certolizumab or ciclosporin allow mothers to maintain clear skin while protecting their baby. Always arrange a pre-conception review with your dermatologist to ensure your treatment plan is optimized for your family goals. In 2026, the clinical consensus is clear: the healthiest outcome for a baby is a mother whose skin and systemic inflammation are well-controlled. 

Authority Snapshot (E-E-A-T Block) 

This guide explains the complex safety protocols for using immunosuppressants during the journey to parenthood. It is written by the MyPatientAdvice Medical Writing/Research Team and reviewed by Dr. Rebecca Fernandez, a UK-trained physician with experience in maternal health and dermatology. All guidance follows the standards provided by the NHS, BSR, and BAD for 2026.