Methotrexate is a drug commonly used for rheumatoid arthritis (RA). Your symptoms may come and go, and may be severe at times. While there’s no cure for RA, medications and other treatments can help control your symptoms. However, if you’re thinking about pregnancy, you likely have many questions. A big one may be, is the methotrexate I take for RA still safe while I’m pregnant?

Methotrexate belongs to a class of medications called disease modifying anti-rheumatic drugs (DMARDs). It reduces inflammation caused by RA by weakening your immune system. This action can help prevent further joint damage and ease the symptoms caused by your RA. Methotrexate can help control your RA, but it can also have dangerous effects on your pregnancy.

The U.S. Food and Drug Administration (FDA) classifies methotrexate as a category X pregnancy drug. Category X drugs should never be used in pregnancy.

There are good reasons for the severe restrictions on methotrexate use during pregnancy. Using methotrexate while you’re pregnant could end your pregnancy or cause severe birth defects. These birth defects could affect the way your child looks, develops, or functions for the rest of his or her life.

Examples of the serious birth defects that methotrexate can cause include:

  • neural tube defects, such as:
    • anencephaly (missing a part of the brain or skull)
    • meningocele (a swollen cyst on the spine filled with cerebrospinal fluid)
    • myelomeningocele (incomplete closing of the spinal cord)
    • encephalocele (sac-like parts of the brain extending out through the skull)
    • spina bifida cystica (a bony defect in the spinal column)
  • cleidocranial dysostosis, which can cause:
    • missing or poorly developed collar bones
    • abnormal skull development
    • bulging of the forehead
  • hypertelorism (increased distance between two body parts, such as the eyes)
  • other malformations such as misshapen ears, flat nose, and undersized jaw
  • abnormal positioning of the hands at the wrist
  • missing bones in the arm

Women should not take this drug if they’re pregnant or trying to become pregnant. If you’re a woman of childbearing age, you should do the following:

  • Take a pregnancy test before starting treatment with methotrexate. Your doctor will likely give you the test in their office.
  • Wait at least one menstrual cycle after you stop taking the drug before you try to get pregnant.
  • Use effective birth control during treatment and for one month after stopping treatment with this drug.
  • If you become pregnant while taking methotrexate, stop taking it and call your doctor right away.

Keep reading: Pregnancy safety concerns for women with RA »

Men who take methotrexate should not get a partner pregnant during treatment with the medication. Men should do the following:

  • Wait at least three months after stopping treatment before trying to get a woman pregnant.
  • Use effective birth control during treatment and for three months after stopping treatment with methotrexate.

You also should not take methotrexate when you’re breastfeeding. This is because methotrexate can cause serious side effects in a child who is breastfed. These side effects can include gastrointestinal problems such as nausea, vomiting, and diarrhea. They can also include blood disorders, such as low levels of blood cells. If your child develops low white blood cell levels, they’re at risk of increased infections. With low red blood cell levels, your child could develop anemia.

If you need to take methotrexate after your baby is born, talk to your doctor about other ways to feed your child.

These methotrexate warnings do not mean you have to stop treating your RA during pregnancy, necessarily. There are other RA drug options that are safe to take during pregnancy. These medications include the following prescription drugs:

Safe options also include low doses of certain corticosteroids. Your doctor can tell you if one of these drugs would be a good match for you.

Also, if your doctor says it’s safe for you, you can take over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) during your first and second trimesters. These NSAIDs include ibuprofen and naproxen. However, you should not take NSAIDs during your third trimester of pregnancy. During that time, NSAIDs can cause serious damage to your baby’s heart.

Read more: NSAIDs for RA »

If you have RA and are pregnant or planning to become pregnant, talk with your doctor. They can tell you more about the effects of methotrexate on pregnancy. They can also advise you about the best RA treatment for you during pregnancy. At your appointment, you can discuss this article and ask any questions you have. These questions might include:

  • How might pregnancy affect my RA?
  • What RA drug options do I have that are safe to use during pregnancy?
  • Are there non-drug ways to reduce RA symptoms during pregnancy?

Together, you and your doctor can create a treatment plan for your RA that’s safe for both you and your pregnancy. In the meantime, you can also read about what to know about RA and pregnancy.


How does pregnancy affect rheumatoid arthritis?


In some cases, pregnancy can increase RA symptoms such as tiredness, pain, and discomfort. This may be due to the extra weight the mother is carrying and the pressure it puts on her joints. Because of these increased symptoms, many women need RA medication during pregnancy. However, in other cases, the symptoms of RA actually improve during pregnancy. As a result, these women may need less medication, or even no medication, while pregnant. However, the RA symptoms typically return after delivery.

Healthline Medical TeamAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.