Prescrire Int. 2010 Oct;19(109):212-3.
Methotrexate is a cytotoxic and immunosuppressant drug mainly used in oncology and rheumatology. It is sometimes used at high doses to treat unruptured ectopic pregnancy. Methotrexate is teratogenic. Malformations reported after exposure in utero include: abnormalities of the skull and face, limb defects, failure of ossification, and congenital cardiopathy.The risk of malformations is probably dose-dependent and seems to be relatively low at the low weekly doses used in rheumatology. Three cases of malformations have been reported after failure of high-dose methotrexate in pregnancies that were misdiagnosed as ectopic. Two newborns had scoliosis, facial dysmorphism, limb malformations, or cardiopathy.The third newborn had minor malformations. In practice, high-dose methotrexate must only be used to treat ectopic pregnancy if the diagnosis has been confirmed. The woman should be informed of the risks to her unborn child in case of diagnostic error or treatment failure.
甲氨蝶呤是一种细胞毒性和免疫抑制药物，主要用于肿瘤学和风湿病学领域。有时会使用高剂量甲氨蝶呤来治疗未破裂的异位妊娠。甲氨蝶呤具有致畸性。宫内接触甲氨蝶呤后报告的畸形包括：头颅和面部异常、肢体缺陷、骨化不全以及先天性心脏病。畸形风险可能与剂量有关，在风湿病学中使用的低每周剂量下，风险似乎相对较低。在误诊为异位妊娠的妊娠中，高剂量甲氨蝶呤治疗失败后报告了3例畸形病例。两名新生儿患有脊柱侧弯、面部畸形、肢体畸形或心脏病。第三名新生儿有轻微畸形。在实际操作中，只有在确诊后才能使用高剂量甲氨蝶呤治疗异位妊娠。应告知女性，如果诊断错误或治疗失败，其未出生胎儿可能面临的风险。
