Date: 2010-07-09

Question:
Hi! I have MS and am on copaxone since May 2009. My boyfriend has been diagnosed with psoriasis arthritis last year, has started to take methotrexate in summer 2009 and is taking about 20mg weekly at the moment. Though we really did not plan on a pregnancy (more the opposite..) I am pregnant now. Can you give me an idea about the potential risk for this child? (the research results I found to methotrexate are all from before 2003.Are there any later studies?) Does it matter how many days have passed after the methotrexate has been taken in the week? Thanks for your help.

Answer:

Consult your physician. The following information should not replace the assessment and advice you have been receiving from your physician (cancer specialist, obstetrician, or other healthcare provider). It is offered for informational and educational purposes only.

With respect to Copaxone, the drug was approved for use in the treatment of MS in 1997, and reproductive animal studies with doses up to 36 times the human dose failed to produce adverse fetal outcomes. Human cases are limited to 33 exposures and the outcomes in these pregnancies have been reassuring. The only two defects found in this group were clubfoot and atrioventicular canal, neither of which can be fully attributed to the use of the medication.

With respect to Methotrexate, research with paternal exposure to the drug has been focused on the effect on sperm quality and count and thus the primary outcome of interest has been on the effects on paternal fertility.

Since pregnancy has already been achieved while partner was on this treatment, fertility is no longer a concern. However fetal exposure through methotrexate contaminated sperm has not been well studied. Considering the negligible exposure through semen, and the absorption of the methotrexate by vaginal walls, it is very unlikely that this type of exposure would carry any risk for the developing fetus. Normal birth outcomes have been reported for parents receiving this therapy.