Extremity Findings of Methotrexate Embryopathy

Hand (N Y). 2020 Jan;15(1):NP14-NP21. doi: 10.1177/1558944719837657. Epub 2019 Sep 22.


Background: Methotrexate (MTX) is widely used as an immunosuppressant, chemotherapeutic, and abortifacient agent. It is also a potent teratogen, and intentional or unintentional exposure during pregnancy is associated with heterogeneous birth anomalies. Methods: We retrospectively reviewed a cohort of patients who presented to our clinic with limb anomalies in the setting of MTX embryopathy. Results: In our case series, we describe 7 cases of patients who had limb anomalies with heterogeneous functionality, from severely debilitating to completely asymptomatic. Most of the upper extremity anomalies in our group were managed conservatively. Conclusions: Methotrexate embryopathy is a rare but clinically important entity with phenotypic and functional variability. This series underscores the need for proper counseling of patients and raises concern regarding using this medication for the purpose of abortion.

Keywords: embryopathy; extremity; methotrexate; oligodactyly.

MeSH terms

  • Abnormalities, Drug-Induced / etiology
  • Abnormalities, Drug-Induced / pathology*
  • Female
  • Fetal Diseases / chemically induced*
  • Humans
  • Infant, Newborn
  • Maternal Exposure / adverse effects*
  • Methotrexate / adverse effects*
  • Pregnancy
  • Retrospective Studies
  • Upper Extremity / pathology
  • Upper Extremity Deformities, Congenital / chemically induced*


  • Methotrexate