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Methotrexate in pregnancy: reply

Methotrexate in pregnancy: reply 698 Letters to the Editor Rheumatology 2005;44:698 When there is inadvertent ingestion of methotrexate during doi:10.1093/rheumatology/keh611 pregnancy or the preconception period, we would agree with the Advance Access publication 29 March 2005 recommendation by Lloyd and colleagues that these cases should be discussed with the National Tetralogy Information Service. The patient and her partner should be informed about available data from the literature. There is a further case report of methotrexate We would like to thank Lloyd and colleagues for their interest in embryopathy being identified prenatally at 26 weeks by ultra- our recent case report. We would certainly agree that any patient sound, and the ultrasound findings were confirmed at autopsy [5]. exposed to any dose of methotrexate during pregnancy or in the A normal ultrasound in this setting certainly does not guarantee 6 months prior to conception is at risk of fetal abnormality. that a fetus is free of teratogenic effects from methotrexate. Our advice to all patients is certainly to avoid methotrexate for at least 6 months prior to conception and during pregnancy. J.E. works as a Remicare liaison nurse for Ashfield Health Care. From the literature, there is a suggestion by Donnenfeld et al. [1] She is seconded to Schering Plough in a non-promotional role. The and Feldcamp et al. [2] that the threshold dose of methotrexate other authors have declared no conflicts of interest. required to produce defects is 10 mg weekly and the vulnerable period of gestation is between 6 and 8 weeks. Given the small number of available case reports and the limited details on the A. J. KINDER,J. EDWARDS ,A.SAMANTA,F.NICHOL timing of methotrexate, we would agree with Lloyd and colleagues Rheumatology, Leicester Royal Infirmary, Leicester and Schering that these suggestions should be considered speculative. We thank Plough, Welwyn Garden City, Hertfordshire, UK Lloyd and colleagues for highlighting a case report of a single Accepted 22 February 2005 7.5 mg dose of methotrexate producing fetal abnormalities. There Correspondence to: A. J. Kinder. E-mail: alisonkinder@ is a further case report of a lady being exposed to 7.5 mg of metho- dsl.pipex.com trexate orally for 2 days at 3.5 weeks of conception. Multiple anomalies were noted on ultrasound at 18 weeks consistent with 1. Donnenfeld AE, Pastuszak A, Noah JS, Schick B, Rose NC, methotrexate embryopathy that was confirmed on fetopsy [3]. Koren G. Methotrexate exposure prior to and during pregnancy. A recent survey of 600 members of the American College of Teratology 1994;49:79–81. Rheumatology, of whom 175 replied, showed 39 patients exposed 2. Feldcamp M, Carey JC. Clinical teratology counseling and to methotrexate during pregnancy; 21 pregnancies resulted in consultation case report: low dose methotrexate exposure in the full-term healthy infants, eight patients had elective abortions early weeks of pregnancy. Teratology 1993;47:533–9. and seven had a spontaneous abortion (with one fetus having 3. Nguyen C, Duhl AJ, Escallon CS, Blakemore KJ. Multiple congenital malformation), and three pregnancies resulted in anomalies in a fetus exposed to low dose methotrexate in the first congenital malformations [4]. However, no further information is trimester. Obstet Gynecol 2002;99:599–602. provided on the nature of the abnormalities and whether they were 4. Chakravarty EF, Sanchez-Yamamoto D, Bush TM. The use of manifestations of the methotrexate syndrome. There is also no disease modifying antirheumatic drugs in women with rheumatoid information on the doses of methotrexate used and the period of arthritis of childbearing age: a survey of practice patterns and exposure during pregnancy. Chakravarty et al. assumed none of these cases had previously been published and produced a pregnancy outcomes. J Rheumatol 2003;30:241–6. combined rate of reported congenital malformation in infants 5. Chapa JB, Hibbard JU, Weber EM, Abramowicz JS, Verp MS. with known outcomes who were exposed to methotrexate in utero Prenatal diagnosis of methotrexate embryopathy. Obstet Gynecol as 17%. 2003;101:1104–7. The Author 2005. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oupjournals.org http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Rheumatology Oxford University Press

Methotrexate in pregnancy: reply

Kinder, A. J.; Edwards, J.; Samanta, A.; Nichol, F.
Rheumatology , Volume 44 (5) – May 29, 2005
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Publisher
Oxford University Press
Copyright
© The Author 2005. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oupjournals.org
ISSN
1462-0324
eISSN
1462-0332
DOI
10.1093/rheumatology/keh611
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Abstract

698 Letters to the Editor Rheumatology 2005;44:698 When there is inadvertent ingestion of methotrexate during doi:10.1093/rheumatology/keh611 pregnancy or the preconception period, we would agree with the Advance Access publication 29 March 2005 recommendation by Lloyd and colleagues that these cases should be discussed with the National Tetralogy Information Service. The patient and her partner should be informed about available data from the literature. There is a further case report of methotrexate We would like to thank Lloyd and colleagues for their interest in embryopathy being identified prenatally at 26 weeks by ultra- our recent case report. We would certainly agree that any patient sound, and the ultrasound findings were confirmed at autopsy [5]. exposed to any dose of methotrexate during pregnancy or in the A normal ultrasound in this setting certainly does not guarantee 6 months prior to conception is at risk of fetal abnormality. that a fetus is free of teratogenic effects from methotrexate. Our advice to all patients is certainly to avoid methotrexate for at least 6 months prior to conception and during pregnancy. J.E. works as a Remicare liaison nurse for Ashfield Health Care. From the literature, there is a suggestion by Donnenfeld et al. [1] She is seconded to Schering Plough in a non-promotional role. The and Feldcamp et al. [2] that the threshold dose of methotrexate other authors have declared no conflicts of interest. required to produce defects is 10 mg weekly and the vulnerable period of gestation is between 6 and 8 weeks. Given the small number of available case reports and the limited details on the A. J. KINDER,J. EDWARDS ,A.SAMANTA,F.NICHOL timing of methotrexate, we would agree with Lloyd and colleagues Rheumatology, Leicester Royal Infirmary, Leicester and Schering that these suggestions should be considered speculative. We thank Plough, Welwyn Garden City, Hertfordshire, UK Lloyd and colleagues for highlighting a case report of a single Accepted 22 February 2005 7.5 mg dose of methotrexate producing fetal abnormalities. There Correspondence to: A. J. Kinder. E-mail: alisonkinder@ is a further case report of a lady being exposed to 7.5 mg of metho- dsl.pipex.com trexate orally for 2 days at 3.5 weeks of conception. Multiple anomalies were noted on ultrasound at 18 weeks consistent with 1. Donnenfeld AE, Pastuszak A, Noah JS, Schick B, Rose NC, methotrexate embryopathy that was confirmed on fetopsy [3]. Koren G. Methotrexate exposure prior to and during pregnancy. A recent survey of 600 members of the American College of Teratology 1994;49:79–81. Rheumatology, of whom 175 replied, showed 39 patients exposed 2. Feldcamp M, Carey JC. Clinical teratology counseling and to methotrexate during pregnancy; 21 pregnancies resulted in consultation case report: low dose methotrexate exposure in the full-term healthy infants, eight patients had elective abortions early weeks of pregnancy. Teratology 1993;47:533–9. and seven had a spontaneous abortion (with one fetus having 3. Nguyen C, Duhl AJ, Escallon CS, Blakemore KJ. Multiple congenital malformation), and three pregnancies resulted in anomalies in a fetus exposed to low dose methotrexate in the first congenital malformations [4]. However, no further information is trimester. Obstet Gynecol 2002;99:599–602. provided on the nature of the abnormalities and whether they were 4. Chakravarty EF, Sanchez-Yamamoto D, Bush TM. The use of manifestations of the methotrexate syndrome. There is also no disease modifying antirheumatic drugs in women with rheumatoid information on the doses of methotrexate used and the period of arthritis of childbearing age: a survey of practice patterns and exposure during pregnancy. Chakravarty et al. assumed none of these cases had previously been published and produced a pregnancy outcomes. J Rheumatol 2003;30:241–6. combined rate of reported congenital malformation in infants 5. Chapa JB, Hibbard JU, Weber EM, Abramowicz JS, Verp MS. with known outcomes who were exposed to methotrexate in utero Prenatal diagnosis of methotrexate embryopathy. Obstet Gynecol as 17%. 2003;101:1104–7. The Author 2005. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oupjournals.org

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Rheumatology – Oxford University Press

Published: May 29, 2005

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