Methotrexate and Pregnancy

With only a few exceptions (such as to end an ectopic pregnancy or when used as chemotherapy), pregnant women should not take methotrexate (Rheumatrex, Trexall). This drug is considered a pregnancy Category X medication, which means that it poses risks to a fetus. Some of the problems that can occur when methotrexate is taken during pregnancy include severe birth defects and miscarriage.

Can Pregnant Women Take Methotrexate?

Methotrexate (Rheumatrex®, Trexall®) is a prescription medication that should be avoided by almost all pregnant women, except in a few circumstances, such as to treat an ectopic pregnancy. This drug can cause miscarriages, birth defects, and other serious problems.

What Is Pregnancy Category X?

The U.S. Food and Drug Administration (FDA) uses a category system to classify the possible risks to a fetus when a specific medicine is taken during pregnancy. Pregnancy Category X is given to medicines that show problems to the fetus in animal studies or in humans who have mistakenly taken the medicine when pregnant.
Methotrexate poses a clear risk to a developing fetus. When taken in early pregnancy, it can cause many different severe birth defects, since it interferes with folic acid. The medication can also cause miscarriages, low birth weight, and dangerously low blood cell counts in the fetus.
Women should avoid becoming pregnant for at least one menstrual cycle after taking methotrexate.

Why Is Methotrexate Used During Pregnancy?

There are a few reasons why this medication may be given to pregnant women. It is sometimes given alone or in combination with misoprostol (Cytotec®) to end a pregnancy intentionally, especially ectopic pregnancies.
It can also be used to treat cancerous complications of pregnancy, such as a molar pregnancy, either to end the pregnancy entirely (if the pregnancy is not viable) or to treat or prevent the cancer after delivery.
Lastly, methotrexate might be used as chemotherapy for a wide variety of cancers if a pregnant woman decides to undergo chemotherapy.
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