Pregnancy after methotrexate

Natalie1712

Hi there,

I have rheumatoid arthritis and have been managing it with weekly methotrexate injections. After speaking with my rheumatologist I came off it to try for a baby. However, it's opnly been 5 weeks and I can feel myself starting to flare up. I take hydroxychloroquine too but know it's safe to take when pregnant.

My rheumatologist told me that the methotrexate would actually be out of my system within 1 week but I am to wait 12 weeks before trying for a baby. I guess my question is why do I have to wait 12 weeks if it will be gone in 1?

I am currently on the pill but will come off that before my 12 weeks to allow my body a natural cycle. I have worked out that when I come off it I will be ovulating 10 weeks after coming off methotrexate. Has anyone else gotten pregnant before the 12 week wait? I wouldn't want to risk myself or my baby but I don't think there is much difference in 2 weeks?

Any help or advise would be appreciated.

Thanks, Natalie

littlemimmy

Hi Natalie,

I don't know much about it, but I take methotrexate in tablet form and recently discussed the possibility of pregnancy with my CNS. I understand that methotrexate actually affects us on a cellular level, so I imagine you're advised to wait twelve weeks to ensure that there will be nothing genetically amiss with your eggs.

If it was me, I would definitely wait, if only for my own peace of mind. It might be worth speaking to someone in your rheumatology team about it - do they have an advice line you can call?

Kay

stickywicket

http://www.arthritisresearchuk.org/arthritis-information/drugs/methotrexate/pregnancy.aspx

What Kay has written makes sense.

I can't believe that meth is out of the system in a week as I had to give it up for abour 5 weeks before a THR and only deteriorated slowly. This is what Arthritis Research UK says about it.

MissKat

I would really wait, it's not worth the risk. Read the Arthritis Research link.

I came off mtx to have my first baby back in 2014, and it had only recently changed from 6 months clear of mtx to 3 months. It's really not that long to wait, I know you've had to plan things more because of being on mtx and it seems like such a long time when you really want a baby, but you really don't want to rush things. Mtx used to be used as an abortion drug, it can cause all sorts of problems for the baby it's really not worth risking it.

I was lucky with my first pregnancy that I didn't flare until 6 months pregnant (this is quite uncommon as usually the pregnancy hormones keep you flare free), and steroids sorted that flare out... can you get some steroid shots to help you at the moment given you are flaring?

For my second pregnancy I took Sulfazalazine throughout and afterwards, which is safe in pregnancy & for breastfeeding. Perhaps you can ask if this drug might work for you?

Please talk to your Rheumy team for advice, they will be able to help you.

Happy to help / advise on any other pregnancy & arthritis questions if you need to - I've been through it all!

Best of luck with everything on your exciting journey ahead & hope your flare settles for you soon x





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Natalie1712

Hi everyone,

Thank you all for getting back to me. I understand what you mean Kay and that makes sense. I was just a bit confused. I would definitely have waited the 12 weeks as wouldn't want to risk anything but I was just curious as to why it was so long. Thank you all for the advice. My flare has calmed down the last couple of days but I have been in touch with my local team to get a steroid injection so hopefully if I flare again I can get one straight away.

MissKat, did you go back on methotrexate after having your baby? I wasn't on any medication before I had my son as I wasn't bad and could manage the pain with ibuprofen. Those were the lucky days! But after having him I flared really badly! Or was the sulfasalazine enough?

I had a really bad flare last year which lasted about 9 months and I got about 5 steroid injections in that time. My local team have a new nurse and when I called the other day she said I can get an injection but I'm only allowed 3 in the year? I've read online that you can have more though and reading other pregnancy blogs people say they have managed the flares with steroids? Surely they will give me more injections than normal due to the circumstances? Does anybody know?

Thanks in advance for any help.

Natalie x

stickywicket

I'd guess that how many steroid jabs you can get will be at the discretion of your local hospital. They are limited because, although they seem to work well, they thin not just the inflamed tissues but others too and too much of them can actually be counterproductive. Maybe, in the case of pregnancy, which is self-limiting, concessions can be made. I think you'd need to ask your rheumatology team.

MissKat

I didn't go back on Methotrexate until 8 weeks ago.

I came off it in Sept 2013 to start the process of having a baby, I didn't get pregnant until March '14, and managed my flare during that pregnancy with steroids.

I wanted to stay off the mtx for as long as I could and I remained flare free until the summer of 2015, which after another spate of steroids is when I went onto Sulfazalazine as we wanted to have another baby in the not too distant future. This worked for me until Jan this year, when I started a bad flare and still am ongoing with it. Steroids didn't do their usual trick for me and only helped for a few days, so I'm now back on mtx and still waiting for it to kick in - things are gradually easing thankfully but it's been a long road to recovery this time round.

My Rheumy team always said to me that the steroids can only be every 3 months (I have them injected straight into the knees), but this may change if you have the one in the bum (!) I'm not sure how that one works and if you can have it more frequently. Best to check with your Rheumy team - they will know best.

Someone on this forum said to me recently that the more steroids you have the less they help in the long run which has sure been the case for me this time.

Hope that all helps... a bit of a long winded one! Best of luck with everything x


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Natalie1712

Thank you both for replying.

My flare has calmed down a bit on its own so I'm going to wait a while longer until I see about getting an injection. We are away on our honeymoon the first week of July so I'm going to wait until as near as possible to that to get it. I want to enjoy my holiday as best I can.

MissKat I hope your flare calms soon. There's nothing worse than having a flare and young children to deal with. I find it very hard at times with my 3 year old.

Thank you both for your help, it's much appreciated. I will definitely wait until after the 3 months to try for a baby x