Multiple anomalies in a fetus exposed to low-dose methotrexate in the first trimester.
BACKGROUND
Methotrexate has multiple therapeutic uses in women of reproductive age including treatment for ectopic pregnancy, neoplastic disease, autoimmune disorders, and inflammatory conditions. More frequent use of methotrexate may result in an increased number of exposures in pregnant women and their fetuses.


METHODS
A 16-year-old gravida 1, para 0 used oral methotrexate treatment of 7.5 mg per day for psoriasis for 2 days at 3.5 weeks postconception. Multiple anomalies were noted on an 18-week ultrasound. Fetopsy revealed craniofacial, axial skeletal, cardiopulmonary, and gastrointestinal abnormalities.


CONCLUSIONS
A minimal, low-dose, brief exposure to methotrexate in the first trimester resulted in a fetus with multiple internal and external malformations. Some of the anomalies (craniofacial and skeletal) have been previously reported with first- trimester methotrexate exposure. This case depicts the association of cardiopulmonary and gastrointestinal abnormalities with methotrexate exposure.
Nguyen
Christine
C
Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Duhl
Adam J
AJ
Escallon
Cathleen S
CS
Blakemore
Karin J
KJ
D000015:Abnormalities, Multiple / Q000139:chemically induced* / Q000000981:diagnostic imaging; D000293:Adolescent; D001842:Bone and Bones / Q000002:abnormalities; D019465:Craniofacial Abnormalities / Q000139:chemically induced / Q000000981:diagnostic imaging; D003863:Depression / Q000150:complications / Q000188:drug therapy*; D004064:Digestive System / Q000000981:diagnostic imaging; D004065:Digestive System Abnormalities; D005260:Female; D005313:Fetal Death / Q000139:chemically induced*; D006330:Heart Defects, Congenital / Q000139:chemically induced / Q000000981:diagnostic imaging; D006801:Humans; D007231:Infant, Newborn; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy*; D011261:Pregnancy Trimester, First; D011565:Psoriasis / Q000150:complications / Q000188:drug therapy*; D020280:Sertraline / Q000627:therapeutic use; D016216:Ultrasonography, Prenatal
D020280:Sertraline; D008727:Methotrexate