Continuing pregnancy after failed methotrexate abortion

I frequently get questions about my statistics on failed medical abortions. I'm going to start addressing those questions here so that everyone has access to this information. I'll start with methotrexate, since I just got a question from Anna about this over the weekend.

The information I have on the website regarding methotrexate exposure was based on research that I did on the internet. First of all, it's very important to understand that the majority of studies that were done on embryos and fetuses were done when the woman was undergoing regular methotrexate treatment for rheumatoid arthritis, cancer, or other conditions. That would mean repeated exposure at high doses. When evaluating the potential risk to the fetus, we need to consider if the exposure was repeated or a one-time thing. A medical abortion with methotrexate uses a small dose given one time.

A couple of other things to mention first...you might see a lot of abortion clinics on the internet warning against continuing a pregnancy after methotrexate (MTX) exposure; however, it's important to remember that they are trying to prevent lawsuits should a deformity occur. You'll read a lot of differing advice on the internet, and it's important to note that no one can guarantee that a baby will or will not be affected.

It's also important to note that during the first 2 weeks after conception, the embryo is not susceptible to teratogenicity (http://www.fda.gov/cber/gdlns/rvrpreg.htm#iii - scroll to "timing of exposure"). Methotrexate abortions should only be done in the first 7 weeks from the first day of your last period.

• http://www.motherisk.org/prof/commonDetail.jsp?content_id=215 This is the main article I based my research on. It has a significant amount of research done, but this research was done for cancer treatment, meaning high, repetitive doses.
• http://faculty.uml.edu/mark_hines/81.452/media/vail.pdf#search=%27methotrexate%20abortion%20dose%27 Particularly the "discussion" section here is helpful
  
• http://www.medicationabortion.com/methotrexate/ Particularly the "side effects and complications" section here
• http://www.prochoice.org/pubs_research/publications/downloads/professional_education/medical_abortion/early_med_abortion_overview_2002.pdf Particularly page 25
• http://rheumatology.oxfordjournals.org/cgi/content/full/44/5/698

Most of these articles point to the fact that 'yes,' methotrexate can cause anomalies at any dose at any time given, but it is considerably less likely that a baby will be born with anomalies after a failed methotrexate abortion because (1) the dose is much lower than that given in cancer or for arthritis treatment and because (2) the dose is not repeated.

If you are having a continuing pregnancy after a methotrexate/misoprostol abortion and you want to remain pregnant, you do not have to have a surgical abortion. The clinic cannot make you have one. Please contact an OB/GYN or a maternal-fetal medicine obstetrician for guidance. Ultrasounds can be done to check for any abnormalities that may be present.

I hope this clears up any questions that anyone may have about a failed methotrexate abortion. Please reply to discuss this further if you would like.

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