Last reviewed: May 2026 | Community resource — not medical advice. Always discuss your specific situation with both a dermatologist experienced in HS and an obstetrician before making any treatment decisions during pregnancy.
Pregnancy is one of the most commonly asked-about topics in the HS community — and one of the least well-served by existing information online. Most resources either say almost nothing useful, or focus only on what medications to avoid without explaining what you can actually do, what to expect from your disease, or how to plan a pregnancy safely when you have HS.
This guide covers all of it: how HS behaves during pregnancy and why, the real data on pregnancy risks associated with HS, which treatments are safe and which to stop, what the 2025 North American clinical guidelines recommend, breastfeeding considerations, what to expect postpartum, and how to plan ahead when you’re thinking about starting a family.
HS in Pregnancy: What the Research Shows About Disease Activity
The first question most patients have is simple: Will my HS get better or worse during pregnancy?
The honest answer is that it varies considerably from person to person — but the research gives us useful probabilities.
A systematic review and meta-analysis published in JAMA Dermatology in 2020 and updated in subsequent reviews found the following pattern across multiple studies:
- Approximately 25–40% of women experience improvement in HS during pregnancy
- Approximately 30–40% experience worsening of disease
- The remainder have relatively stable disease
- More than 50–70% experience a postpartum flare — often within weeks of delivery
A 2025 systematic review published in the International Journal of Dermatology by Özbek et al. confirmed these findings, noting that “flares are widely reported during pregnancy and postpartum, underscoring the need to consider management strategies tailored to pregnant or lactating individuals.”
📚 Reference: Özbek L et al. “Hidradenitis Suppurativa Treatment During Pregnancy and Lactation: Navigating Challenges.” International Journal of Dermatology, 2025. PubMed
📚 Reference: Ghanshani R et al. “A Guide to the Management of Hidradenitis Suppurativa in Pregnancy and Lactation.” American Journal of Clinical Dermatology, 2025. PMC
Why does HS fluctuate so much during pregnancy?
Pregnancy involves dramatic hormonal shifts — surges in oestrogen, progesterone, and human chorionic gonadotropin (hCG), followed by an altered immune system profile designed to prevent rejection of the foetus. These same hormonal and immune changes that affect so many other conditions also affect HS:
First trimester: Hormonal fluctuation is most volatile. Some women experience immediate worsening; others notice early improvement as oestrogen rises.
Second trimester: The immune system shifts toward a more anti-inflammatory profile (Th2 dominance) during mid-pregnancy — this is thought to explain why some women with autoimmune and inflammatory conditions, including HS, improve during this period.
Third trimester: Physical factors come into play — increased friction and sweating in HS-prone areas from weight gain and abdominal growth, particularly in the groin, thighs, and under the breasts. Even women who improved earlier in pregnancy may experience worsening in the third trimester for these mechanical reasons.
Postpartum: This is when the risk is highest. The post-delivery hormonal crash — particularly the sharp drop in oestrogen and progesterone — combined with the physical stress of delivery, sleep deprivation, and the immune system recalibrating back to its pre-pregnancy state creates the conditions for significant flares. Over half of HS patients experience a postpartum flare, and for many it is more severe than their pre-pregnancy baseline.
“My HS was actually the best it had been in years during my second trimester. I made the mistake of reducing my treatment thinking I was getting better. Three weeks after my daughter was born I had the worst flare of my life.” — HS Warriors member
Pregnancy Outcomes: What the Research Shows About Risk
This is an important section to read carefully. Recent research has identified that HS during pregnancy is associated with higher rates of certain complications compared to pregnancies without HS. These findings do not mean that having HS makes a healthy pregnancy impossible — the vast majority of HS patients do have healthy pregnancies. But they do mean that closer monitoring and proactive management matter.
The landmark JAMA Dermatology study (2024)
The most comprehensive study to date, published in JAMA Dermatology in October 2024 by Li et al., analysed 1,324,488 deliveries in Quebec, Canada between 2006 and 2022. Of these, 1,332 (0.1%) were to mothers with HS. The researchers tracked outcomes up to 16 years.
Maternal outcomes during and after pregnancy:
- Higher risk of hypertensive disorders of pregnancy (including gestational hypertension and, in some studies, preeclampsia)
- Higher risk of gestational diabetes
- Higher rates of caesarean delivery
- Mothers with HS had 2.29 times the risk of hospitalisation later in life compared to controls
Neonatal outcomes:
- 28% higher risk of preterm birth (RR 1.28; 95% CI 1.07–1.53)
- 29% higher risk of birth defects (RR 1.29; 95% CI 1.07–1.56)
- Specifically elevated risks of congenital heart defects (RR 1.57) and orofacial clefts (RR 4.27, though the absolute risk remains low)
- Children of mothers with HS had a 31% higher risk of hospitalisation over childhood for various conditions
📚 Reference: Li K, Piguet V, Croitoru D et al. “Hidradenitis Suppurativa and Maternal and Offspring Outcomes.” JAMA Dermatology, October 2024. doi:10.1001/jamadermatol.2024.3584
A separate systematic review and meta-analysis published in Clinical and Experimental Dermatology in 2026 confirmed these associations, finding HS was significantly linked to spontaneous abortion (OR 1.19), preterm birth (OR 1.17), and birth defects (OR 1.47).
📚 Reference: Systematic review: “Adverse pregnancy outcomes among pregnant women with hidradenitis suppurativa.” Clinical and Experimental Dermatology, 2026. Oxford Academic
Putting these numbers in context
These relative risk figures sound alarming, but need contextualisation:
The absolute risk still remains relatively low. A 28% increased relative risk of preterm birth means moving from roughly 10% in the general population to approximately 13% — a real difference, but not a dramatic absolute increase.
HS patients have higher rates of comorbidities — including obesity, PCOS, metabolic syndrome, smoking, and socioeconomic disadvantage — that independently increase pregnancy complications. The JAMA study adjusted for many of these factors, but it is difficult to fully disentangle HS-specific effects from comorbidity effects.
Active, poorly controlled HS likely carries higher risk than well-managed HS. The researchers explicitly noted that early detection and conscientious management could help mitigate these risks. This is one of the strongest arguments for optimising HS treatment before and during pregnancy, not stopping treatment.
The key message is not “HS makes pregnancy dangerous” — it is “HS in pregnancy warrants closer monitoring and proactive care from a multidisciplinary team.”
Treatments During Pregnancy: What’s Safe and What to Stop
This is where the information becomes most practically critical. Many standard HS treatments cannot be used during pregnancy. Others are safe and remain appropriate. And a small but important number are now supported by strong clinical guideline recommendations specifically for pregnant patients.
In January 2025, the American Academy of Dermatology published landmark North American Clinical Practice Guidelines for the Medical Management of HS in Special Patient Populations — including a dedicated section on pregnancy and breastfeeding with 27 specific recommendations. This is the most authoritative guidance currently available.
📚 Reference: Alhusayen R et al. “North American clinical practice guidelines for the medical management of HS in special patient populations.” JAAD, 2025. JAAD
What to STOP before or early in pregnancy
Tetracyclines (doxycycline, lymecycline, minocycline): CONTRAINDICATED from the second trimester onward (risk of permanent dental staining in the baby’s developing teeth and bones). A strong recommendation in the 2025 guidelines to avoid oral doxycycline during pregnancy. Many clinicians avoid it from conception.
Spironolactone: CONTRAINDICATED throughout pregnancy. Spironolactone is an anti-androgen that can cause feminisation of a male foetus. Stop this before conception.
Oral retinoids (isotretinoin/Roaccutane): ABSOLUTELY CONTRAINDICATED — one of the most teratogenic drugs in existence. Causes severe birth defects including facial, cardiac, and neurological malformations. Must be stopped before conception and requires a mandatory pregnancy prevention programme (iPLEDGE in the US). Not typically used for HS anyway, but worth knowing.
Rifampicin as monotherapy: Use with caution during pregnancy due to potential teratogenic concerns. The combination of clindamycin alone (without rifampicin) may be preferred in pregnant patients who need oral antibiotics.
Oral erythromycin: The 2025 guidelines include a strong recommendation to avoid oral erythromycin during pregnancy due to an increased risk of elevated liver enzymes and other adverse outcomes.
Hormonal contraceptives: Obviously discontinued when pregnant. Note that combined oral contraceptives are sometimes used therapeutically in HS — this benefit is lost during pregnancy.
What is SAFE or recommended during pregnancy
Topical clindamycin 1%: Generally considered compatible with pregnancy. The topical application results in minimal systemic absorption. Supported as first-line local treatment during pregnancy across multiple guidelines.
Antiseptic washes (chlorhexidine, benzoyl peroxide wash): Generally considered compatible. Low systemic absorption; useful for reducing surface bacterial load and managing mild flares locally.
Oral clindamycin (systemic): Generally considered compatible for defined courses. When systemic antibiotics are needed during pregnancy, oral clindamycin is one of the preferred options. The 2025 guidelines list it as compatible.
Amoxicillin-clavulanic acid, cephalexin, cefdinir, metronidazole: All listed as generally compatible in the 2025 guidelines for defined antibiotic courses during pregnancy.
Zinc supplementation: The 2025 North American guidelines include a strong recommendation for the use of zinc supplements during pregnancy in HS patients. Zinc has anti-inflammatory effects and deficiency is common in HS; it is safe in appropriate doses during pregnancy.
Metformin: Listed as generally compatible in the guidelines. Metformin is used in some HS patients (particularly those with insulin resistance, PCOS, or obesity) and is well-studied in pregnancy from its use in gestational diabetes and PCOS management.
Intralesional corticosteroid injections: Injections into individual lesions to reduce acute inflammation are generally considered safe during pregnancy for managing acute flares. Systemic absorption is minimal.
Incision and drainage / deroofing (surgical): Procedural management under local anaesthesia is generally safe during pregnancy for managing acute abscesses and established tunnels. Discuss anaesthesia choices with your obstetrician.
Biologics in pregnancy: the current guidance
Biologics require the most nuanced discussion, but the 2025 guidelines are clearer than many patients expect.
Adalimumab (Humira): The 2025 guidelines include a strong recommendation for the use of adalimumab in pregnant HS patients who require biologics. Adalimumab has more pregnancy safety data than any other HS biologic. It does cross the placenta — particularly in the third trimester — so neonates born to mothers on adalimumab should not receive live vaccines for the first 6 months of life (consult a paediatrician). The guidelines recommend continuing use throughout pregnancy rather than stopping.
Certolizumab pegol (Cimzia): A TNF inhibitor approved for other inflammatory conditions (not specifically for HS, but sometimes used off-label). Uniquely among biologics, certolizumab has minimal placental transfer due to its molecular structure (it lacks the Fc region that facilitates placental transport). The 2025 guidelines list it as generally compatible throughout pregnancy, and it is considered by many HS specialists as the preferred biologic for patients planning or currently pregnant.
Infliximab: May be used with caution in patients who need biologics and for whom adalimumab is not suitable. The 2025 guidelines note it does not significantly increase pregnancy risks but advise the same neonatal live vaccine precaution.
Secukinumab (Cosentyx) and bimekizumab (Bimzelx): Limited safety data in pregnancy. The guidelines note these may be used when necessary but that further research is needed. Available data from the Novartis global safety database for secukinumab showed no clear signals of increased miscarriage or congenital malformations from 292 known pregnancies, but the sample sizes are small.
The key principle across biologics: The 2025 guidelines explicitly endorse continuing biologic therapy throughout pregnancy rather than stopping — a significant shift from older, more conservative advice that often told patients to stop biologics on discovery of pregnancy. The risk of uncontrolled HS during pregnancy (with its associated systemic inflammation and comorbidities) must be weighed against the risk of biologic exposure, and for most patients with moderate-to-severe disease, continued treatment is the better-supported choice.
You should not stop any biologic without discussing it with your dermatologist and obstetrician first. Abrupt cessation can cause rapid disease rebound.
Treatment Safety Summary Table
| Treatment | Pregnancy | Breastfeeding |
|---|---|---|
| Topical clindamycin 1% | ✅ Compatible | ✅ Compatible |
| Antiseptic washes (chlorhexidine, BPO) | ✅ Compatible | ✅ Compatible |
| Oral clindamycin | ✅ Compatible | ⚠️ Use with caution (GI effects in infant) |
| Amoxicillin-clavulanic acid | ✅ Compatible | ✅ Compatible |
| Doxycycline / tetracyclines | ❌ Avoid (strong recommendation) | ⚠️ Limit use |
| Erythromycin | ❌ Avoid (strong recommendation) | — |
| Rifampicin (oral) | ⚠️ Caution (teratogenic risk) | ⚠️ Compatible (conditional) |
| Spironolactone | ❌ Contraindicated | ✅ Compatible |
| Zinc supplementation | ✅ Strong recommendation | ✅ Compatible |
| Metformin | ✅ Compatible | ✅ Compatible |
| Adalimumab | ✅ Strong recommendation if biologics needed | ✅ Strong recommendation if biologics needed |
| Certolizumab pegol | ✅ Compatible (minimal placental transfer) | ✅ Compatible |
| Infliximab | ⚠️ May be used with caution | ✅ Compatible |
| Secukinumab, bimekizumab | ⚠️ Limited data — discuss with specialist | ⚠️ Limited data |
| Isotretinoin / retinoids | ❌ Absolutely contraindicated | ❌ Contraindicated |
| Intralesional corticosteroids | ✅ Generally safe | ✅ Generally safe |
Based on the 2025 North American Clinical Practice Guidelines (JAAD) and the 2025 International Journal of Dermatology systematic review.
Breastfeeding with HS
Disease activity after delivery
As noted above, the postpartum period carries a high risk of HS flares for most patients. This is not a reason to avoid breastfeeding — but it is a reason to have a treatment plan in place before delivery, not to improvise one when you’re exhausted and recovering with a newborn.
Postpartum flares typically begin within the first 1–4 weeks after delivery and can be severe. Having your dermatologist on standby, having a prescription for a topical or systemic antibiotic ready to fill if needed, and knowing that this is expected rather than a sign that something has gone wrong, all reduce the distress of postpartum flares.
Biologics during breastfeeding
The 2025 guidelines specifically state that biologics are likely safe during breastfeeding due to their large molecular size, which results in minimal transfer into breast milk. Even where trace amounts are present, they are unlikely to be absorbed significantly by the infant’s gastrointestinal tract.
Adalimumab: A strong recommendation in the 2025 guidelines for use during breastfeeding in patients who require biologics.
Infliximab: Detectable in small amounts in breast milk of some mothers (one study found concentrations up to 0.74 μg/mL in 66% of breastfeeding mothers), but no significant differences in infections or developmental milestones were found in breastfed infants compared to controls.
Certolizumab: Generally compatible; listed as compatible in the 2025 guidelines for breastfeeding.
Antibiotics during breastfeeding
Oral rifampicin: Conditional recommendation for use during breastfeeding in patients who need systemic antibiotics. The oral clindamycin-rifampicin combination is often used after delivery but with monitoring.
Oral clindamycin: Use with caution during breastfeeding due to the potential for gastrointestinal adverse effects (including Clostridioides difficile-associated diarrhoea) in the nursing infant.
Amoxicillin-clavulanic acid, cephalexin, metronidazole: All listed as compatible with breastfeeding in the guidelines.
Spironolactone: Notably, spironolactone — which is contraindicated in pregnancy — is listed as generally compatible with breastfeeding. If spironolactone was helping your HS before pregnancy and was stopped, it can potentially be restarted once breastfeeding is established, with appropriate discussion with your doctor.
Important: Live Vaccine Timing for Your Newborn
If you have been on adalimumab, infliximab, or other biologics during your third trimester, your baby will have some of this drug in their system at birth. This is important for one specific reason: live vaccines must not be given to the baby during the first 6 months of life if you were on a biologic in the third trimester.
This affects:
- Rotavirus vaccine (a live oral vaccine given at 8 weeks in many countries — this may need to be delayed or discussed with your paediatrician)
- BCG vaccine (live vaccine for tuberculosis, given at birth in some countries — discuss with your paediatrician and neonatologist)
- MMR (given at 12 months in most countries — no issue at standard timing)
The 2025 guidelines include a strong recommendation to consult with a paediatrician on the timing of live vaccines for neonates with in-utero biologic exposure. Do not wait until the first vaccine appointment to have this conversation — tell your midwife, obstetrician, and birth hospital about your biologic treatment before delivery.
Planning a Pregnancy: What to Do Before You Conceive
If you are thinking about starting a family and have HS, the ideal situation is to have a planned conversation with your dermatologist before you begin trying. This allows:
Medication review and adjustment in advance. Stopping spironolactone, switching from doxycycline to a pregnancy-safe antibiotic, reviewing whether your biologic needs to be changed — these adjustments are far easier to make in a planned way before pregnancy than in the emergency of a positive test.
Disease optimisation before conception. Entering pregnancy with well-controlled HS reduces the risk of severe flares during pregnancy and reduces systemic inflammatory burden. If you are on suboptimal treatment, this is the time to escalate.
Supplementation. Starting folic acid (as for all women planning pregnancy) and zinc supplementation (given the 2025 strong recommendation) before conception.
Establishing obstetric care. Telling your obstetrician or midwife about HS before conception allows them to plan for closer monitoring, particularly for hypertension and gestational diabetes screening.
Mental health preparation. Pregnancy with HS can be emotionally complicated — uncertainty about disease course, concern about treatment safety, fear about passing a genetic predisposition to your child. Having mental health support established before pregnancy, not during a crisis, is genuinely helpful.
The Genetic Question: Can HS Be Inherited?
HS does have a genetic component. Research suggests that approximately 30–40% of HS cases have a family history of the condition, with mutations in genes encoding the γ-secretase complex (NCSTN, PSENEN, PSEN1) identified in some familial cases.
What this means practically:
- There is a real but not certain chance that a child of a parent with HS could develop the condition
- Having the genetic predisposition does not guarantee HS will develop — environmental and hormonal factors also play a role
- HS typically does not manifest until puberty or early adulthood, even in genetically predisposed individuals
This is a question worth discussing with your dermatologist if it concerns you. Genetic testing for HS is not currently part of routine clinical practice but can be arranged in specialist centres if you have a strong family history or a known mutation.
Delivery Considerations
There is no absolute contraindication to vaginal delivery for most HS patients. However, certain situations warrant discussion with your obstetric team:
Active perianal or perineal HS: Significant active disease in the perineum, buttocks, or perianal area may influence delivery planning. Some obstetricians may recommend caesarean section if vaginal delivery would involve passing through or causing significant trauma to areas of active HS, though this decision is highly individual.
Post-surgical scarring: Extensive scarring from prior HS surgery in the groin or perineum may affect delivery options — discuss this with your obstetrician.
Increased caesarean risk: The Quebec cohort study found higher rates of caesarean delivery in HS patients, though this likely reflects the higher rates of comorbidities and the specific presentations described above rather than HS being a universal contraindication to vaginal delivery.
Building Your Care Team During Pregnancy
The best outcomes for pregnant HS patients come from coordinated care involving multiple specialists. Ideally, this team includes:
- Dermatologist experienced in HS: manages disease activity, prescribes appropriate treatments, monitors for flares
- Obstetrician or maternal-fetal medicine specialist: manages pregnancy monitoring, screens for gestational complications, advises on delivery
- Paediatrician: consulted in advance about biologic exposure and vaccine timing
- Mental health support: a therapist or psychologist familiar with chronic illness, particularly if anxiety about pregnancy and HS is significant
If your current dermatologist is not experienced with HS in pregnancy, this is one of the strongest reasons to seek a second opinion or referral to a specialist centre. The treatment decisions around pregnancy are nuanced, and general dermatologists may be unfamiliar with the 2025 guidelines.
The HS Warriors Community
Many HS Warriors members have navigated pregnancy — some with easy courses, some with difficult ones, all with hard-won knowledge that can help someone else. If you’re pregnant with HS, planning a pregnancy, or supporting someone who is, our community is here.
👉 Pregnancy and HS discussions in our forums 👉 Personal stories from the community 👉 Mental health and emotional support 👉 Find a dermatologist experienced in HS 👉 Join HS Warriors — free and anonymous
This article is for informational purposes only. It does not constitute medical advice. Treatment decisions during pregnancy are highly individual and must be made in consultation with a dermatologist experienced in HS and an obstetrician. Do not start, stop, or change any medication during pregnancy without medical supervision.
Sources & Further Reading:
- Li K et al. “Hidradenitis Suppurativa and Maternal and Offspring Outcomes.” JAMA Dermatology, October 2024. doi:10.1001/jamadermatol.2024.3584
- Ghanshani R et al. “A Guide to the Management of HS in Pregnancy and Lactation.” Am J Clin Dermatol, 2025. PMC
- Özbek L et al. “HS Treatment During Pregnancy and Lactation: Navigating Challenges.” Int J Dermatol, 2025. PubMed
- Alhusayen R et al. “North American clinical practice guidelines for the medical management of HS in special patient populations.” JAAD, 2025. JAAD
- “Adverse pregnancy outcomes among pregnant women with HS: systematic review and meta-analysis.” Clinical and Experimental Dermatology, 2026. Oxford Academic
- “Hidradenitis Suppurativa in Pregnancy Raises Risk for Some Adverse Outcomes.” Medscape, May 2026. Medscape
- “Impact of Pregnancy on HS Disease Course: A Systematic Review and Meta-Analysis.” PubMed, 2021. PubMed
- American Academy of Dermatology. HS Clinical Guidelines. aad.org
- HS Foundation. Patient resources. hs-foundation.org
- National Institutes of Health — PubMed HS pregnancy research. PubMed