In every pregnancy, a woman begins with a 3-5% opportunity of having a baby with a birth defect. This is called her background risk. This sheet speak about whether direct exposure to methotrexate might increase the risk for abnormality over that background risk. This info should not fill in treatment and guidance from your healthcare service provider.
What is methotrexate?
Methotrexate is a medication that can stop the growth of cells and can hinder the immune system. Methotrexate is prescribed to treat numerous conditions, consisting of cancers and autoimmune conditions like rheumatoid arthritis and psoriasis.
Methotrexate is likewise used to treat ectopic pregnancies (ones that grow outside the uterus). It can be taken by mouth, intravenous injection or intramuscular injection. Methotrexate is recommended in a range of dosages including low dosages for rheumatoid arthritis to high doses for cancer.
Methotrexate decreases the body’s ability to break down and use folic acid. During pregnancy, folic acid is important for regular development of the baby.
How long does methotrexate remain in the body?
Everyone’s capability to break down medication is various. The time for methotrexate to leave the body also differs with dosage. However, methotrexate is mainly cleared from the body within one week after the last dose is taken. Particular medications might decrease the clearance of methotrexate. People who have reduced kidney function or a condition that leads to additional body fluid might clear methotrexate more slowly.
I have just recently been treated with methotrexate for an ectopic pregnancy. For how long should I wait prior to I try to become pregnant once again?
Before you attempt to become pregnant again, you must confirm with your healthcare company that the ectopic pregnancy has actually been treated and you are not pregnant. Your health care service provider might wish to monitor your levels of hCG (a hormone produced during pregnancy) in order to validate you are not pregnant. When this is verified, your healthcare supplier may recommend waiting one to six months before aiming to conceive to ensure the medication has been cleared from the body.
Will my previous methotrexate use make it harder for me to get pregnant?
Probably not. One small study found that women who were treated with methotrexate for an ectopic pregnancy might be less effective with treatment for infertility within 6 months of direct exposure to the drug. Nevertheless, this finding was not validated in other studies. Women who are actively trying to conceive need to not be taking methotrexate!
Does direct exposure to methotrexate cause an increased risk for miscarriage?
Since methotrexate can be used to terminate pregnancies or treat ectopic pregnancies, it promises that methotrexate use in early pregnancy would increase the risk of a miscarriage. Small research studies have reported an increased risk for miscarriage; however, there weren’t adequate women followed to properly assess the level of risk.
Can taking methotrexate in pregnancy cause birth defects?
YES. Using methotrexate in the first trimester has been connected with a specific pattern of birth defects. This pattern of abnormality consists of malformations of the babies’ head, face, and bones. Poor growth and developmental delay have also been described. For other abnormality, like heart defects and oral clefts, the proof is presently not strong enough to show that methotrexate is the cause.
There is some minimal proof to recommend that a pregnant woman will be at risk for having a baby with methotrexate-related abnormality if she takes 10 mg or more of methotrexate each week in between 6 and 8 weeks after conception (8 to 10 weeks after the first day of her last menstrual period). More info concerning the threats with specific timing and dose of methotrexate are needed to draw firm conclusions.
One 2009 review paper reported no increase in abnormality or miscarriage rates in 101 women with rheumatoid arthritis who were exposed to 5-25mg/ week of methotrexate in the first trimester. While reassuring, this paper does not imply there is no risk for low dose methotrexate direct exposure in the first trimester.
Is it OKAY to reboot methotrexate after the first trimester?
No. Methotrexate ought to be avoided after the first trimester. During the second and third trimesters of pregnancy, the baby is still growing and the brain is still establishing. Poor growth and learning problems have been connected with methotrexate, so use after the first trimester is a potential issue.
I am presently taking methotrexate, however would like to become pregnant. For how long do I need to wait to end up being pregnant after I stop taking methotrexate?
Some health care suppliers suggest waiting one to six months after stopping methotrexate to make sure the medication has actually been cleared from the body. However, there are no reports of women who stopped methotrexate any time before conception and after that had a baby with the pattern of birth defects related to methotrexate.
If I get pregnant while taking methotrexate, what should I do?
Contact your health care provider immediately. Your healthcare company can discuss your particular threats, as well as suggest prenatal testing.
Prenatal testing might include a blood or amniotic fluid test for neural tube flaws (such as spina bifida) and an in-depth ultrasound to look at the growth and development of the baby. Ultrasound can show some birth defects associated with methotrexate, however is unable to identify all potential problems caused by a methotrexate direct exposure.
Can I take methotrexate while breastfeeding?
There are no research studies taking a look at the results of methotrexate in the breastfed baby. Methotrexate passes into breast milk in small amounts. Since of its toxic properties and possible accumulation of the drug in a baby’s body, the American Academy of Pediatrics does not suggest methotrexate in breastfeeding.
Some researchers believe that low-dose methotrexate, such as the dose used for the treatment of rheumatoid arthritis, is a low risk to the breastfed baby. If a woman and her health care company choose to continue methotrexate treatment in breastfeeding, tracking of the baby’s blood count is suggested. Make certain to speak with your health care supplier about all your options for breastfeeding.
If a man uses methotrexate, will it cause infertility or birth defects in the baby?
Methotrexate might cause an increased risk for infertility, not birth defects. Low sperm count has been seen in some men using methotrexate. The majority of these men were using high doses of the medication, as well as other medications used to treat cancer. Sperm levels went back to regular after the men stopped using methotrexate.
There are no reports recommending that men who use methotrexate at the time of conception are most likely to father a baby with a birth defect. 3 studies kept in mind no increase in abnormality in the children of 65 men who had actually taken methotrexate around the time of conception. However, due to general concern instead of actual dangers, some healthcare suppliers recommend that men wait at least 3 months after stopping methotrexate prior to attempting to develop.