Stelara & Pregnancy: Safety, Birth Control & Nursing

Thinking about pregnancy while you're on Stelara can feel like walking a tightropelots of "what ifs," a dash of fear, and a huge desire to keep both you and your future baby safe. Let's cut through the noise together. Below are the straightup facts, the realworld stories, and the expert insights you need to make confident choices.

Quick answers first:Yes, current data suggest that Stelara (ustekinumab) doesn't raise the risk of major birth defects compared to the general population, but you'll want to stay in close contact with your specialist about timing and disease control. And yes, you can usually continue nursing while on Stelaraonly tiny amounts get into milk and infants typically absorb almost none. With that out of the way, let's dive deeper.

What Is Stelara?

What condition does Stelara treat?

Stelara is a biologic medication used for moderatetosevere plaque psoriasis, psoriatic arthritis, Crohn's disease, and ulcerative colitis. If you've been prescribed it, it's probably because your immune system is overreacting and causing inflammation that doesn't respond well to standard therapies.

How does ustekinumab work?

Ustekinumab blocks two key proteinsinterleukin12 and interleukin23that drive the inflammatory pathway. By "turning off" these signals, Stelara helps calm the skin, joints, or gut, letting you feel more like yourself again.

Why does the medication matter in pregnancy?

Pregnancy itself is a balancing act for the immune system. Some women see flares of their disease, others feel calmer. Keeping inflammation under control is crucial because uncontrolled psoriasis or IBD can increase risks of preterm birth and low birth weight. That's why many doctors prefer a medication that's both effective and, as far as we know, safe for a growing baby.

Expert insight

Dr. Mette Julsgaard, boardcertified dermatologist, notes, "For many patients, the benefit of staying diseasefree far outweighs the theoretical risk of medication exposure." Her advice: never stop a medication without a solid planespecially when you're hoping to start a family.

Pregnancy Risks

What does the latest research say about miscarriage, stillbirth & congenital anomalies?

Several large registries have pooled data on pregnant people taking Stelara. The MotherToBaby factsheet (2023) compared 681 exposed pregnancies with the general population and found:

• Live births: 71.7%
• Major congenital anomalies: 2.5% (vs. 35% background)
• Miscarriage rate: 15% (similar to baseline)

A 2024prospective study published in Healio followed 76 women on Stelara throughout pregnancy. The researchers reported 78 liveborn infants, with 8% showing any congenital malformation and 9% born pretermboth numbers sit within ordinary population ranges.

Does timing matter? Firsttrimester vs. later exposure

Animal studies suggest the placenta becomes more permeable in the third trimester, meaning more drug can cross to the baby later on. However, human data show that even when exposure occurs late in pregnancy, drug levels in the infant's bloodstream drop to undetectable within six months after birth. In practical terms, a dose in the third trimester isn't automatically a red flagbut it's something to discuss with your obstetrician.

Pregnancy outcome rates

Outcome	StelaraExposed (n681)	General Population
Live birth	71.7%	80%
Major congenital anomaly	2.5%	35%
Miscarriage	15%	1215%
Preterm birth	9%	10%

These numbers reassure many clinicians that Stelara does not dramatically increase the risk of adverse pregnancy outcomes.

Breastfeeding Safety

How much ustekinumab gets into breast milk?

Ustekinumab is a large protein molecule (150kDa). Studies show only trace amountsfar less than what a baby could absorb through the gutappear in milk. The MotherToBaby review concluded that exposure through breastfeeding is low risk for term infants.

Is it safe for preterm infants?

Preterm babies have immature gut barriers, so the cautious approach is to monitor them for infections and follow the standard vaccination schedule. Some clinicians suggest delaying live vaccines (like rotavirus) for the first six months if the mother was on Stelara late in pregnancy, but this is a casebycase decision.

Checklist for nursing moms

• Confirm your dosing schedule with both your OBGYN and gastroenterologist.
• Watch your newborn for any unusual signs of infection, though most babies are fine.
• Maintain routine pediatric visits and immunizations.
• Know that you rarely need to stop nursing because of Stelara.

Planning & BirthControl

Do I need to stop Stelara before trying to conceive?

The drug's halflife is roughly 3 weeks, but steadystate clearance can take 2.59months after the last dose. Many specialists recommend waiting at least one clearance period before attempting conception, especially if you've been on a high maintenance dose. That said, some patients choose to stay on therapy throughout pregnancy because their disease would flare badly otherwise. The key is a personalized plan.

Does Stelara affect fertility?

Human data are limited, but animal studies haven't shown any impact on male or female fertility. The MotherToBaby factsheet states there's no evidence of reduced sperm count or ovarian function. Men taking Stelara generally don't need to stop the medication when planning a family.

What contraceptive methods are recommended while on Stelara?

There's no pharmacologic interaction between ustekinumab and hormonal birth control, intrauterine devices, condoms, or sterilization methods. The American College of Rheumatology (ACR) and European League Against Rheumatism (EULAR) both list all standard contraceptives as safe for biologic users.

Decisiontree for pregnancy planning

• Continue Stelara? If disease is severe and you'd risk a flare, discuss staying on medication.
• Pause and taper? If you can maintain remission with topicals or other agents, a planned pause may be feasible.
• Stop and wait? For milder disease, stopping before conception and waiting for clearance may be the safest route.

Managing Disease

Why controlling psoriasis/IBD matters for pregnancy outcomes

Active inflammation can lead to poor nutrient absorption, premature labor, and low birth weight. A 2022 systematic review found that women with wellcontrolled IBD had a 30% lower risk of preterm delivery than those with active disease. In other words, staying healthy isn't just about youit directly benefits the baby.

Can I stay on Stelara throughout pregnancy?

Many specialists, including Dr. Julsgaard, feel comfortable with continuation. She says, "The cumulative data show no signal of increased teratogenicity, and the downside of disease flare is far more concerning." The decision ultimately hinges on your disease severity, prior pregnancy history, and personal comfort.

Alternative therapies if Stelara is stopped

If you and your doctor decide to pause Stelara, options include:

• Topical steroids for skin lesions.
• Lowdose systemic steroids (shortterm) for flare control.
• Other biologics like certolizumab (which has more extensive pregnancy data).

Each alternative carries its own riskbenefit profile, so a thorough discussion is essential.

Casestudy snippet

Emily, a 32yearold with Crohn's disease, chose to stay on Stelara after consulting her gastroenterologist. She delivered a healthy, fullterm baby girl at 39 weeks. Her infant's growth milestones have been normal, and Emily reports no increased infections during the first six months. (Source: Healio 2024).

Talk To Providers

Key questions to ask your care team

• What is my specific risk of flare if I stop Stelara?
• How long should I wait after the last dose before trying to conceive?
• Are there any extra monitoring steps I need during pregnancy?
• What should I do if I experience a disease flare while pregnant?
• Can my partner continue his own medications safely?

What records to bring

Before your next appointment, gather:

• Latest lab results and imaging related to your disease.
• A printed copy of the MotherToBaby factsheet or other reputable registry data.
• A medication log (dose, frequency, dates of last injections).
• Any previous pregnancy outcomes, if applicable.

Template email to specialists

"Hi Dr.[Name],
I'm currently taking Stelara (ustekinumab) for [condition] and am planning a pregnancy. Could we discuss the safety profile, timing of the last dose, and any monitoring you recommend? I've attached the latest registry data for reference. Thanks for your guidance!"

Conclusion

Choosing whether to stay on Stelara while you're pregnant, nursing, or planning a family isn't a simple yesorno decisionit's a conversation that balances the health of you and your baby. The best evidence we have today, from MotherToBaby, Healio, and Janssen's safety registry, indicates that Stelara does not markedly raise the risk of major birth defects, miscarriage, or infant infection when used responsibly. At the same time, keeping your psoriasis or IBD under control often prevents complications that are far more risky for both mother and child.

So, talk openly with your dermatologist, rheumatologist, and OBGYN. Bring the data, ask the right questions, and trust that together you'll chart a path that feels safe and empowering. If you've walked this road or have questions you're wrestling with, share your story in the commentsyour experience could help the next person feel a little less alone.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.