“One question I’m scared to ask, though😣: Does HS affect me in any way with pregnancy?” a member of myHSteam wrote. If you have hidradenitis suppurativa (HS), it’s possible to have a healthy and safe pregnancy with support and guidance from your doctors. Talking with your dermatologist and obstetrician about what to expect during pregnancy, delivery, and the postpartum period (after delivery) can help expectant parents with HS have more confidence during this exciting, but nerve-wracking, life stage.

To gain a better understanding of what to expect during and after pregnancy, myHSteam talked with Dr. Kelsey Flood, a board-certified dermatologist at Northwestern Memorial Hospital in Chicago and assistant professor of dermatology at Northwestern University Feinberg School of Medicine. Dr. Flood treats long-term skin diseases like HS and offers insights into what to expect throughout and after pregnancy when living with this inflammatory skin condition.

HS Treatments During Pregnancy

Not all medications for HS are safe to take during pregnancy. These include:

• Methotrexate
• Systemic retinoids like isotretinoin
• Antibiotics like tetracycline, minocycline, and doxycycline
• Spironolactone
• Birth control pills

Dr. Flood shared, “I always ask patients of childbearing age to let me know if they’re planning to conceive so we can have a discussion about the safety data of each treatment.”

Although many medications are not an option if you’re pregnant or planning to become pregnant, you still have choices for managing your HS. Several medications are generally considered safe to use during pregnancy:

• Topical antibiotics — Antibiotics that you put directly on the skin
• Oral antibiotics — Antibiotics taken by mouth (some may be safely used)
• Biologics — Medications that target specific parts of the immune system to reduce inflammation
• Systemic drugs — Medications taken orally or by injection that affect the entire body

Talk with your dermatologist and obstetrician-gynecologist (OB-GYN) about the medications you’re taking to treat your HS. “There’s a lot of information, and it can be overwhelming. So just make sure you have a dedicated prenatal/preconception visit planned to ask about treatments and other concerns,” said Dr. Flood.

Knowing about the safety of treatment options when trying to conceive and during pregnancy can help you feel more confident about a safe and healthy pregnancy for you and your baby.

HS Symptoms During Pregnancy

One concern many people with HS have is whether their condition will be affected, for better or for worse, during pregnancy. There is some research on this topic, but everyone is different.

"Unfortunately, we don’t have a good way to predict who’s going to get better, who’s going to get worse, and who’s going to stay the same,” Dr. Flood said. “It’s the same with a lot of inflammatory skin problems in that they can be a little bit unpredictable, and we don’t have a nuanced enough understanding of how people will change,” she added.

In a 2019 survey, 279 people responded to questions about how their HS condition was affected during pregnancy. About one-third of those who answered reported that their HS symptoms were unchanged during pregnancy, while the other two-thirds were fairly evenly split, with just over 34 percent saying their symptoms worsened and almost 37 percent reporting their symptoms improved.

In a study from 2008 to 2018 in Michigan, 127 women with HS were monitored to determine whether their symptoms worsened during pregnancy. Results showed that symptoms became worse in 70 pregnancies, while no changes in symptoms were reported for 34 pregnancies. Improved symptoms were noted in only nine pregnancies. The study also showed that HS worsened during the postpartum period in 82 of 124 pregnancies.

In a systematic review, which is a detailed summary of all the studies on a particular topic, symptoms improved during pregnancy in nearly 25 percent of self-reported cases in eight studies. Around 20 percent of participants mentioned that their symptoms got worse during this time. The review also showed that 60 percent of women had a postpartum HS flare.

Members of myHSteam also shared their experiences:

• “For me, pregnancy made it worse. Every time. Different triggers and different areas were affected, and each time was a different kind of uncomfortable.”
• “As I recall, my HS was way worse when I was pregnant. I remember crying a lot!”
• “My skin has settled, and my pregnancy seems to have calmed my skin down a lot! I’m still getting flare-ups, but not as intense as before.”
• “For me, pregnancy was flawless when it came to HS flare-ups. I had one small flare, and that was it. I was so blessed.”

HS-Related Pregnancy Complications

People with HS may be at an increased risk of pregnancy complications compared with the general population. “This is something that you and your OB should be aware of, especially if you have certain comorbidities [two or more medical conditions at the same time] like hypertension, diabetes, obesity, smoking, or heart disease, since those are risk factors for potentially developing complications,” Dr. Flood explained.

In a four-year analysis of more than 1,800 pregnancies in people with HS versus more than 64,000 pregnancies without HS, researchers found that those who had HS had a higher risk of:

• Miscarriage — Naturally occurring pregnancy loss
• Preterm birth — Birth before 37 weeks of pregnancy
• Stillbirth — Death of a baby after 28 weeks in the womb or during delivery
• Gestational diabetes — Diabetes beginning or first recognized during pregnancy
• Gestational hypertension — High blood pressure during pregnancy
• Preeclampsia — A condition characterized by high blood pressure, protein in the urine, swelling, headaches, and/or blurry vision
• Cesarean birth (C-section or cesarean section) — Surgical removal of the baby, rather than a vaginal birth

If you’re living with HS, Dr. Flood recommends a visit with a board-certified OB-GYN and a board-certified dermatologist to care for your obstetric and HS needs before and during pregnancy. If you have additional health risk factors that could affect the likelihood of developing complications, Dr. Flood suggests considering a high-risk OB-GYN, also called a maternal-fetal medicine specialist.

Childbirth and Postpartum

HS may affect your childbirth and postpartum experience. Several factors, including your anatomy, underlying health conditions, and personal preferences, come into play.

Labor and Delivery

People with HS are more likely to have a C-section than a vaginal birth compared to those without HS. Dr. Flood mentioned that it’s also important to consider your anatomy when talking with your doctor about your options for delivery: “If you have a high burden of disease [how much an illness affects your life] in the vulva, there might be more pain, which will impact whether you have a vaginal birth or a C-section.”

Dr. Flood noted, “Someone who only has disease from the waist up and not a lot of vulvar disease doesn’t have to worry as much about painful lesions bursting and draining during the delivery process.” She suggests talking about this with your dermatologist and your OB-GYN: “See if there is anything they can do before delivery to locally manage your disease or wound care [treat the issue in a specific area without affecting the entire body] if you really prefer a vaginal delivery. Knowing your body and your burden of disease can help you advocate for yourself.”

Postpartum

For some people, the postpartum period brings relief from HS flares and symptoms, while others experience additional complications.

In the review previously mentioned, from the journal Dermatology, five studies looked into the effects of HS in the postpartum period. Four of these studies noted worsening of HS in 60 percent of cases. The fifth study noted postpartum HS flares in those who had a vaginal delivery, with 23.5 percent of women with anogenital HS (affecting the genital organs or anus) who delivered vaginally believing that their HS flares were caused by having a vaginal delivery.

It can be helpful to create a plan before delivery about how you will manage your physical health, your mental health, and the care of your baby during the postpartum period. You can talk to your dermatologist about possible adjustments to your treatment plan depending on your symptoms. You can also discuss child care for when you need to go to the doctor. Your doctors can talk to you about signs of postpartum depression or anxiety.

Breastfeeding

If you would like to breastfeed, the treatments you used during pregnancy are likely appropriate while nursing, Dr. Flood noted. Make sure to keep communication open with your health care team to make sure the treatments you’re using are safe and work well while breastfeeding.

“If breastfeeding is really important to you and you also have a high burden of breast disease, try to work with your dermatologist to have a clear understanding of what topical therapies you can use on your breasts,” she explained.

“For my patients, I always tell them if you have a flare, let me know so you can come in, and we can treat it locally. Having a plan established for how to take care of this painful lesion so I can keep breastfeeding my infant would be important,” Dr. Flood said.

The Bottom Line

Pregnancy can have an impact on HS, but when you work closely with dermatologists, obstetricians, and other specialists, you can make informed choices to make your pregnancy smoother and more comfortable. If you plan to breastfeed, getting support from lactation consultants can also be helpful. Staying well informed and receiving advice from your doctors can make a big difference in how you feel while managing HS during pregnancy.

Talk With Others Who Understand

On myHSteam, the social network and online community for people with hidradenitis suppurativa and their loved ones, more than 35,000 members come together to ask questions, give advice, and share their stories with others who understand life with HS.

Are you living with HS and pregnant or trying to become pregnant? Ask questions and share your experience in the comments below, or start a conversation on your Activities page.