Managing eczema during pregnancy puts clinicians in a tough spot — hormonal changes can trigger or worsen flares, but most medications haven't been studied in pregnant patients. That's because pregnant and lactating women have historically been excluded from clinical trials, largely due to ethical and liability concerns, creating what researchers call a significant "void" in the evidence base.

To help fill that gap, MotherToBaby has launched an observational study recruiting pregnant women in the U.S. and Canada with moderate to severe atopic dermatitis to evaluate the safety of lebrikizumab (Ebglyss), an IL-13 inhibitor approved in 2024. The study will run through 2033 and aims to give both patients and providers the data they need to make informed treatment decisions.

Key Takeaways:

• Avoid during pregnancy: Methotrexate, mycophenolate mofetil, JAK inhibitors, and photochemotherapy carry known or suspected fetal risks
• Use with caution: Oral corticosteroids and cyclosporine may be used sparingly when safer options fail
• Considered safe: Topical corticosteroids, topical calcineurin inhibitors, wet wraps, and phototherapy are recommended first-line options
• Dupilumab: No contraindication listed on its label, and some studies suggest positive maternal outcomes — but data remain limited

Why it matters: Uncontrolled eczema during pregnancy isn't just uncomfortable — it can lead to staph infections that pose risks to both mother and baby. Better evidence means better, safer care for a population that has long been left out of the research equation.