Methotrexate and pregnancy : Just wondering if anyone... - NRAS

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Methotrexate and pregnancy


Just wondering if anyone has been in a similar situation with this drug?

I have been prescribed Methotrexate since all other drugs seemed to have failed. My only concern is the fact that I haven't started a family as yet and I'm afraid of the horrible side effects it can cause - birth defects/abnormalities

Been advised to use a more reliable form of contraception which means I'll have to plan my pregnancy. It's very difficult and can't help but stress about this.

Can anyone relate or been through this difficult decision before and how did you cope?

Thank you x

5 Replies


You will have to plan carefully as you don't want to mix methotrexate and pregnancy. I had the same experience 19 years ago - I had been on methotrexate for a few years to control my RA. At that point I had to come off the methotrexate 6 months before trying to get pregnant and use an alternative medication. I'm not sure what is the best available (and safe) alternative now - I think I got by on basic anti inflammatories but I must have taken something else. I do remember it was a relief to get pregnant and being pregnant offered better relief. Some women go into 'full remission' whilst pregnant.

I suppose you need to weigh up the benefits you can get in the short to medium term with the need to plan very carefully - if you were thinking of having a baby relatively soon, it might not be worth it. I was in my 20s without a long term partner when I went on methotrexate and I did respond well to the drug, so it was worth it for me.

Best of luck


in reply to BMM62

Just to add that after being on mtx, coming off it for 6 months and then getting pregnant quite quickly, my pregnancy was pretty straight forward and my son was unaffected and developmentally had no difficulties. In fact he's just started at Oxford uni!

This is an interesting fact sheet.

There is a risk and you should use precautions but if you do get pregnant by accident this paragraph is good to know

'One 2009 review paper reported no increase in birth defects 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 mean there is no risk for low dose methotrexate exposure in the first trimester.'

If starting a family is important to you ask to switch your medication. Hydroxychloroquine is licensed for use during pregnancy and Sulphasalazine (although not licensed) has been used by 1000s of pregnant ladies, including myself, with no known side effects.


If you are keen to start a family, you need to talk to your rheumy team about this. Methotrexate takes a long time to work and a long time to get out of your system, so is not the easiest drug to fit together with a pregnancy.

You might look up the other drugs - the NRAS site is very clear- and perhaps think about hydroxychloroquine.

BUT you also need to be prepared for having more symptoms while waiting to get pregnant, feeling much better while you are pregnant (most people) and having a flare after delivery (most people) when you are breast feeding, coping with a small baby, not having any sleep etc. It isn't easy according to most people who post on here, but of course, the people who don't have problems don't post!

I was "fortunate" in that my RD didn't start until my children were older and I must say that they were super and coped with a mum who sometimes couldn't do things wonderfully well. But I also had excellent treatment and was never out of action for too long, although I have had, over the years, a lot of steroids as well as other DMARDs! (I'm also fortunate to have good bones and no diabetes).

Hi She8987, I haven't got a story of having a baby after mtx but I am in the same situation as you, I also don't have children yet and am 28. Diagnosed in January was 27 then and had been trying for a baby seriously for around 5 months. Was put on sulfasalazine as this is considered to be a safe dmard for pregnancy. I wished, hoped and prayed it would suit me so I could get pregnant but it didn't agree with me at all.

Saw rheumy in May and of course was given the option of methotrexate. I knew this would be the treatment plan but nothing prepared me for actually hearing the words. I felt like my world came crashing down. This was because me and my partner were so excited to start a family and I knew methotrexate would end all that excitement and adventure together. For now. As well as stress/worry/anxiety of taking a medication that causes birth defects etc. And having to decide when to 'un' control RA at some point in the future, what a decision!

Whilst it is something that people tell you 'will happen when the time's right', 'you are still young etc etc' for me making a decision to stop a life plan I had felt like RA was/is controlling another part of my life.

You don't say if pregnancy is an imminent thing or is a consideration for you at this point, but if you would like a family, I was told that steroid tablets can also be an option? I don't know if you've explored this already.

There isn't much support that I've seen for people wanting to start a family who are making choices around medication, and whilst info from nras is good around contraception etc, I don't feel understanding about the emotional side of having to plan pregnancy with a medication constraint is well documented or readily available hence my reply to you 😊 Don't even get me started on my issue with the minuscule pregnancy friendly treatment options available for a female dominated illness (no offence to guys intended). Just seems ridiculous.

I put off taking methotrexate for another 5 months in hope that something might happen (it didn't) but arheumatology nurse did give me some comforting words: if you find a treatment that works at least you're one step ahead when you do give birth for post birth treatment, so I now think of this as preparation time for controlling the disease in the future.

i don't find much research out there too helpful in terms of real study numbers: it would be unethical to conduct as study that truly looked at birth defect rates, and some studies truly contradict themselves.

I hope you find a contraception option that works for you, and fingers x for mtx working too. Sorry for long reply


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