The American Journal of Medicine
Volume 122, Issue 11 , Pages 998-1000 , November 2009

Improving Pregnancy Counseling for Women with Rheumatoid Arthritis Taking Methotrexate

  • Naama Neeman, MSc

      Affiliations

    • Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Mass
    • Stoneman Center for Quality Improvement and Patient Safety, Boston, Mass
    • ,
  • Mark D. Aronson, MD

      Affiliations

    • Stoneman Center for Quality Improvement and Patient Safety, Boston, Mass
    • Department of Medicine, Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Mass
    • Harvard Medical School, Boston, Mass
    • ,
  • Joanne E. Schulze, BA

      Affiliations

    • Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Mass
    • Stoneman Center for Quality Improvement and Patient Safety, Boston, Mass
    • ,
  • Robert H. Shmerling, MD

      Affiliations

    • Harvard Medical School, Boston, Mass
    • Department of Medicine, Division of Rheumatology, Beth Israel Deaconess Medical Center, Boston, Mass
    • Corresponding Author InformationRequests for reprints should be addressed to Robert H. Shmerling, MD, Clinical Chief, Division of Rheumatology, Robinson Firm Chief, Department of Medicine, Beth Israel Deaconess Medical Center, 110 Francis St, Suite 4B, Boston, MA 02215

References 

  1. Saag KG, Teng GG, Patkar NM, et al. American College of Rheumatology 2008 recommendations for the use of nonbiologic and biologic disease-modifying antirheumatic drugs in rheumatoid arthritis, 2008 update. Arthritis Rheum. 2008;59:762
  2. Chakravarty EF, Sanchez-Yamamoto D, Bush TM. The use of disease modifying antirheumatic drugs in women with rheumatoid arthritis of childbearing age: a survey of practice patterns and pregnancy outcomes. J Rheumatol. 2003;30:241
  3. Ostensen M, Hartmann H, Salvesen K. Low dose weekly methotrexate in early pregnancy (A case series and review of the literature). J Rheumatol. 2000;27:1872
  4. Kozlowski RD, Steinbrunner JV, MacKenzie AH, et al. Outcome of first-trimester exposure to low-dose methotrexate in eight patients with rheumatic disease. Am J Med. 1990;88:589
  5. Ostensen M, Khamashta M, Lockshin M, et al. Anti-inflammatory and immunosuppressive drugs and reproduction. Arthritis Res Ther. 2006;8:209
  6. Buckley LM, Bullaboy CALeichtman, et al. Multiple congenital anomalies associated with weekly low-dose methotrexate treatment of the mother. Arthritis Rheum. 1997;40:971
  7. Janssen NM, Genta MS. The effects of immunosuppressive and anti-inflammatory medications on fertility, pregnancy, and lactation. Arch Intern Med. 2000;160:610–619
  8. Maini RN. Patient information: disease modifying antirheumatic drugs (DMARDs)UpToDate 2007. http://www.uptodate.com/patients/content/topic.do?topicKey=∼tZKOrn__cLNnQ/Accessed Sept 1, 2009
  9. Donnenfeld AE, Pastuszak A, Noah JS, et al. Methotrexate exposure prior to and during pregnancy. Teratology. 1994;49:79–81
  10. Aronson MD, Neeman N, Carbo A, et al. A model for quality improvement programs in academic departments of medicine. Am J Med. 2008;121:922–929

 Funding: Stoneman Center for Quality Improvement and Patient Safety, Department of Medicine, Beth Israel Deaconess Medical Center.

 Conflict of Interest: None of the authors have any conflicts of interest associated with the work presented in this manuscript.

 Authorship: All authors had access to the data and played a role in writing this manuscript.

PII: S0002-9343(09)00675-5

doi: 10.1016/j.amjmed.2009.07.009

The American Journal of Medicine
Volume 122, Issue 11 , Pages 998-1000 , November 2009

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