Biological agents in pregnancy and lactation – A rational approach

Biologicals are a rapidly evolving group of drugs derived from biological agents which target specific immune mediators. The use of biologicals in dermatology is on the rise, especially for inflammatory and immunological conditions. As pregnancy and lactation are associated with exacerbation of various inflammatory conditions necessitating administration of biologicals in certain cases, their use in these physiologically altered states has to be evaluated. This article aims at reviewing the common biologicals used in dermatology and their feasibility in pregnancy and lactation. Tumor necrosis factor-alpha inhibitors are the most experienced group of biologicals in pregnancy and lactation, the newer biologicals have only animal studies and isolated case reports to back up their use. The commonly used biologicals are tabulated and discussed herewith. The guidelines and recommendations are derived from the data of use in other conditions such as inflammatory bowel disease and rheumatoid arthritis as there is no sufficient literature evidence for the use of biologicals in pregnancy for dermatological conditions. It was extrapolated that biologicals, being large molecular weight immunoglobulins or recombinant proteins, may be used with judicious care in the first two trimesters of pregnancy and after the 1 st week of lactation, if benefits to the mother outweigh the theoretical risk to the infant.