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Methotrexate in Early Pregnancy — RACP Adult Medicine MCQ

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ModerateRheumatologyMethotrexate in Early PregnancyRACP Adult Medicine

A 32-year-old woman with RA on methotrexate discovers she is 6 weeks pregnant (unplanned). She stopped methotrexate immediately upon positive pregnancy test. What is the most important immediate step?

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Correct answer: D — Start high-dose folic acid and refer to maternal-fetal medicine

Methotrexate is a potent teratogen (folate antagonist) associated with aminopterin syndrome. It should have been stopped ≥3 months before conception. With early exposure and immediate cessation, outcomes may be acceptable, but high-dose folic acid (5 mg daily) and urgent referral to maternal-fetal medicine for counselling and detailed fetal anomaly assessment is essential. Individual risk assessment is needed.

Reference: EULAR – 2024 – Medications in Pregnancy; TGA 2024