AMINOPTERIN

Fetal Risk Summary

Aminopterin is an antimetabolite antineoplastic agent. It is structurally similar to and has been replaced by methotrexate (amethopterin). Several reports have described fetal anomalies when the drug was used as an unsuccessful abortifacient (1,2,3,4,5,6,7 and 8). The malformations included:   Meningoencephalocele Cranial anomalies Abnormal positioning of extremities Short forearms Hydrocephaly Talipes Incomplete skull ossification Cleft lip/palate Low-set ears Hypoplasia of thumb and fibula Brachycephaly Anencephaly Mental retardation Syndactyly Micrognathia or retrognathia Use of aminopterin in the 2nd and 3rd trimesters has not been associated with congenital defects (8). Long-term studies of growth and mental development in offspring exposed to aminopterin during the 2nd trimester, the period of neuroblast multiplication, have not been conducted (9).

Breast Feeding Summary

No data are available.

References

1. Meltzer HJ. Congenital anomalies due to attempted abortion with 4-aminopteroglutamic acid. JAMA 1956;161:1253.
2. Warkany J, Beaudry PH, Hornstein S. Attempted abortion with aminopterin (4-amino-pteroylglutamic acid). Am J Dis Child 1959;97:274–81.
3. Shaw EB, Steinbach HL. Aminopterin-induced fetal malformation. Am J Dis Child 1968;115:477– 82.
4. Brandner M, Nussle D. Foetopathic due à l'aminoptèrine avec sténose congènitale de l'escpace mèdullaire des os tubulaires longs. Ann Radiol 1969;12:705–10.
5. Shaw EB. Fetal damage due to maternal aminopterin ingestion: follow-up at age 9 years. Am J Dis Child 1972;124:93–4.
6. Reich EW, Cox RP, Becker MH, Genieser NB, McCarthy JG, Converse JM. Recognition in adult patients of malformations induced by folic acid antagonists. Birth Defects 1978;14:139–60.
7. Shaw EB, Rees EL. Fetal damage due to aminopterin ingestion: follow-up at 17 1/2 years of age. Am J Dis Child 1980;134:1172–3.
8. Nicholson HO. Cytotoxic drugs in pregnancy; review of reported cases. J Obstet Gynaecol Br Commonw 1968;75:307–12.
9. Dobbing J. Pregnancy and leukemia. Lancet 1977;1:1155.