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As a father, will taking methotrexate affect our unborn child?

Q) I've taken methotrexate and adalimumab for three years. My wife and I are now expecting a child. This should be a happy occasion but we're concerned because the medical advice is against having a family while taking methotrexate. Information on the internet about the risks to the unborn child if the man is taking a low dose of methotrexate is confused. Most of the research seems to be based on the woman taking methotrexate and points to the risk of severe deformity. What is the effect of taking methotrexate on the unborn child if it's the man taking the drug? What are the risks and what tests are available at which stages of the pregnancy?
Marc Holland, Dorking, Surrey (Autumn 2011)

A) The advice given out is quite clear. Both men and women who take methotrexate are advised against trying for a family unless they've discontinued the drug for at least three months. The evidence in humans may not be strong but there's animal evidence and the manufacturer (and most rheumatology departments) recommend discontinuation. In your case your wife is already pregnant. You should indicate to the obstetrician that you were taking methotrexate during conception and they'll be alerted to any problems during the pregnancy and at any time during the pregnancy when screening tests are done for foetal abnormalities, usually at 18 weeks. Sometimes it may be necessary to look for abnormalities by taking a sample of fluid from the foetal sac. I must stress that the overall risks are very small.


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