Question:
A pregnant mother at 35 weeks of gestation with SLE. Which of the following drugs cannot be used?
A pregnant mother at 35 weeks of gestation with SLE. Which of the following drugs cannot be used?
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Which of these is a teratogenic folate antagonist contraindicated in pregnancy?
Updated On: Jun 24, 2026
- Prednisolone
- Methotrexate
- Sulfasalazine
- Hydroxychloroquine
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The Correct Option is B
Solution and Explanation
Step 1: The scenario is management of systemic lupus erythematosus (SLE) in pregnancy, so drugs must be assessed for fetal safety.
Step 2: Methotrexate is a folate antagonist and is a well-known teratogen and abortifacient. It is absolutely contraindicated in pregnancy because it causes congenital malformations and fetal loss. Therefore it CANNOT be used, making option B the answer.
Step 3: Confirm the safe alternatives. Prednisolone is largely inactivated by placental 11-beta-hydroxysteroid dehydrogenase and is considered acceptable in pregnancy for controlling lupus activity, so option A is allowed.
Step 4: Hydroxychloroquine is regarded as safe and is in fact recommended to be continued throughout pregnancy in lupus, so option D is allowed. Sulfasalazine is also considered compatible with pregnancy (with folate supplementation), so option C is allowed.
Step 5: The drug that cannot be used is methotrexate, option B.
Step 2: Methotrexate is a folate antagonist and is a well-known teratogen and abortifacient. It is absolutely contraindicated in pregnancy because it causes congenital malformations and fetal loss. Therefore it CANNOT be used, making option B the answer.
Step 3: Confirm the safe alternatives. Prednisolone is largely inactivated by placental 11-beta-hydroxysteroid dehydrogenase and is considered acceptable in pregnancy for controlling lupus activity, so option A is allowed.
Step 4: Hydroxychloroquine is regarded as safe and is in fact recommended to be continued throughout pregnancy in lupus, so option D is allowed. Sulfasalazine is also considered compatible with pregnancy (with folate supplementation), so option C is allowed.
Step 5: The drug that cannot be used is methotrexate, option B.
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