Therapeutic Abortions with a Folic Acid Antagonist, 4-Aminopteroylglutamic Acid (4-Amino P. G. A.) Administered by the Oral Route

Abstract

1. Oral doses of 6 to 12 mg. 4-amino P. G. A. induced fetal death in the first trimester of pregnancy followed by spontaneous delivery of the products of conception in 10 out of 12 cases treated. 2. The doses lethal to the embryos had only a slight and transitory depressing effect on the hemoglobin and white blood counts of the mothers. 3. In three instances, a second course of the drug was given needlessly because of persistent positive “pregnancy tests.” 4. The lesions found in the younger fetuses were depression of hematopoiesis, necrosis of the liver, adrenals, and intestinal epithelia. 5. In three older fetuses the drug failed to produce immediate death, but apparently induced malformations of the cranium. One of these fetuses died later and was delivered spontaneously. The other two were alive when surgically removed. 6. The study shows that usage of the drug to induce abortions should in the absence of reliable pregnancy tests be limited to patients in whom surgical intervention is possible to avoid malformations. 7. The action of the drug is regarded as entirely “antifolic,” indicating the importance of folic acid in the early embryonic life. 8. The probable role of a folic acid deficiency in certain spontaneous abortions, in the development of malformations, and the importance of folic acid in seasonal breeding in some species is suggested by this study.