Can methotrexate be used during pregnancy?

• A. Yes, with fetal monitoring
• B. Only in the first trimester
• C. Only after delivery
• D. No

Answer: (D)

Methotrexate is a folate antagonist that disrupts DNA synthesis in rapidly dividing cells, making it highly teratogenic. Because exposure in pregnancy can cause neural tube defects, other congenital abnormalities, and miscarriage, it is contraindicated throughout pregnancy. Therefore it cannot be used during pregnancy; if a patient becomes pregnant while taking methotrexate, it should be stopped immediately and pregnancy managed with obstetric input. For women planning pregnancy, methotrexate should be discontinued well before conception and replaced with safer alternatives appropriate for pregnancy. Monitoring does not make methotrexate safe during pregnancy.