Methotrexate in early pregnancy may not cause defects

December 29, 2004

2004-12-29 11:45:49 -0400

NEW YORK (Reuters Health) - Methotrexate is a potent drug that induces

abortion at high doses, and is used at low doses to treat conditions like

rheumatoid arthritis. There has been concern that women taking low-dose

methotrexate and don't realize they've become pregnant could have babies

with birth defects.

Now comes word from French researchers that the risk does not seem to be

very great.

In a small study, Dr. Thierry Vial, of Centre de Pharmacovigilance in Lyon

and colleagues examined the risk of major malformations of the fetus among

pregnant women who were treated with low-dose methotrexate in early-stage

pregnancy.

A total of 28 cases were included in the final analysis, published in the

Journal of Rheumatology.

Twenty-six of the women ended methotrexate treatment before 8 weeks of

gestation. Four patients had spontaneous abortions and five had elective

abortions.

Overall, there were a total of 19 live births. Of these, three were

premature. The full-term children all had birth weights within the expected

range, according to the investigators.

One child had minor anomalies, including a deformity of the feet and an

eyelid angioma. One premature infant had jaundice, and another infant had

transient respiratory distress and jaundice.

Methotrexate is an anti-folate drug, and this may be how it causes adverse

effects, Vial's team points out. They say it is therefore especially

important for women on methotrexate to heed the recommendation for all women

to take folate supplements before pregnancy.

" This recommendation also applies to patients without preconception folinic

acid supplementation who have inadvertently continued methotrexate after the

beginning of pregnancy, " they write

SOURCE: Journal of Rheumatology, December 2004.

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