Pregnancy After Ectopic Pregnancy: What to Expect & Next Steps

Question
Hi,
I had an ectopic pregnancy in June 2011 for which I was given methotrexate, single dose. My initial hcg was close to 4000. I was doing blood tests and it came down to 200 after approx 4 weeks and then I stopped going for bloodwork as I got busy. I had done several urine hpt and they have been negative since July. Last week I had a positive hpt and bloodwork confirmed pregnancy at 2599. UltrasounD shows early pregnancy with gestational sac consistent with less than 5 weeks. I am concerned because I didn't follow my betas down to zero after the ectopic. Could this pose a problem for me and/oR the fetus?  Also, since I wasn't trying for a pregnancy, I had not been taking prenatal vitamins. Specifically, do you think I should be concerned that I have not been taking folate when I had methotrexate 4 months before I conceived? Should I take a higher dose right now?  
Also, 2 days ago I had pain of the same quality and location as when I had my ectopic...I also had that feeling in Sept during menstration. Thoughts?

Answer
As far as your first query goes, there will be no harm to the baby even if you did not follow up the level of beta hcg.

The second question is quite tricky to answer.Methtrexate is a folate antagonist( meaning it opposes the effect of folate). Therefore it is theoretically possible that methotrexate taken four moths prior to this pregnancy may affect your baby, but I am of the opinion that this is quite improbable. This is because methotrexate is washed out from the body in a months time and as long as you have been eating a balanced diet, it looks unlikely that your baby will have any problems. But I can't say this with 100% accuracy. Therefore I would advice you to take a higher dose of folic acid(You can take even 20 mg per day). Taking higher doses of folic acid will not harm you or your baby. Also be under regular follow up with your Obg/gyn.

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