Pregnancy
All approved biologics for psoriasis treatment are classified as pregnancy FDA category B (no risk from animal studies, but no adequate and controlled studies in women). Evidence from many hundreds of pregnancies in inflammatory arthritis and inflammatory bowel disease have suggested that exposure to TNFi at the time of conception or during the first trimester does not result in an increased risk of adverse pregnancy and fetal outcomes. Certolizumab-pegol lacks an Fc receptor, thus active placental transport is not thought to occur, a finding that has been confirmed in women. Drug experience during pregnancy is extremely limited with ustekinumab. There are some case reports of use of ustekinumab during pregnancy in psoriasis patients with uncomplicated pregnancies and healthy infant deliveries, and one report of a spontaneous abortion during ustekinumab therapy. No data related to apremilast and pregnancy are available. In a pregnant women who requires biologic treatment during pregnancy, TNFi would be the best choice, and within them probably certolizumab-pegol.