Pregnancy Outcome After Methotrexate Treatment for Rheumatic Disease Prior to or During Early Pregnancy: A Prospective Multicenter Cohort Study

Abstract

Objective. High-dose methotrexate (MTX) exposure during pregnancy is associated with embryopathy.The teratogenic potential of MTX at dosages typically used in the treatment of rheumatic diseases remains uncertain. The aim of this study was to evaluate the risk of spontaneous abortion, major birth defects, elective termination of pregnancy, shortened gestational age at delivery, and reduced birth weight in women exposed to MTX.Methods. Pregnancy outcome in women taking MTX (<30 mg/week) either after conception or within the 12 weeks before conception was evaluated in a prospective observational multicenter cohort study. Pregnancy outcomes in the MTX group were compared to outcomes in a group of disease-matched women and a group of women without autoimmune diseases (neither group was exposed to MTX).Results. The study sample included 324 MTXexposed pregnancies (188 exposed post-conception, 136 exposed pre-conception), 459 disease-matched comparison women, and 1,107 comparison women without autoimmune diseases. In the post-conception cohort, the cumulative incidence of spontaneous abortion was 42.5% (95% confidence interval [95% CI] 29.2-58.7), which was significantly higher than the incidence of spontaneous abortion in either comparison group. The

Pregnancy and rheumatoid arthritis

“…As MTX is known to be teratogenic and to induce miscarriages, it should be avoided during pregnancy [87,90]. In general, it is advised to stop MTX 3 months before a planned pregnancy [91]; however, recent evidence suggests that a shorter period might also be appropriate [90].…”

“…In general, it is advised to stop MTX 3 months before a planned pregnancy [91]; however, recent evidence suggests that a shorter period might also be appropriate [90]. MTX can be detected in small amounts in breast milk and should be stopped because of a theoretical risk [87].…”

Effect of Methotrexate Treatment for Ectopic Pregnancy on Current and Subsequent Pregnancy

“…To date, the largest prospective observational study failed to show an increased risk of abnormal pregnancy outcomes (stillbirth, spontaneous abortion, major, and minor birth defects) in women chronically treated with low dose MTX (median weekly dosage 15 mg; range 2.5-30 mg) up to 10 weeks prior to LMP compared to healthy control and disease matched women unexposed to MTX [11]. In contrast, those treated during the first trimester had a higher risk of congenital malformations, although not compatible with the aminopterin syndrome.…”

Gravidez, Aleitamento e Fármacos em Dermatologia - Tratamento Sistémico

“…[87][88][89] A taxa de abortamento durante o tratamento com metotrexato é de aproximadamente 40%, consideravelmente mais elevada do que a observada na população em geral ou mesmo em doentes com doenças autoimunes. 90 Um intervalo mínimo de um a três meses entre a interrupção do metotrexato e a conceção é recomendado. 5,91 O metotrexato é excretado no leite e, embora as concentrações aqui obtidas sejam baixas, pode acumular-se em recém-nascidos com função renal imatura, devendo por isso ser evitado durante a amamentação.…”