I did a quick medline search for further info on MTX prior to conception and did find a more recent review article (though I'm not really familiar with this journal, so I don't know if it is peer reviewed): Lloyd ME. Carr M. McElhatton P. Hall GM. Hughes RA. The effects of methotrexate on pregnancy, fertility and lactation. [Review] [101 refs] [Journal Article. Review] Qjm. 92(10):551-63, 1999 Oct. They have a paragraph on MTX prior to conception stating: "After administration, methotrexate is widely distributed in body tissues, the highest concentrations being in the kidneys, gallbladder, spleen, liver and skin. Its presence in the liver has been reported up to 116 days after exposure, although the amount of drug retained does not appear to be related to the dose received.7,49 There is thus a theoretical risk of fetal exposure in babies of mothers who have taken the drug up to 4 months prior to conception. Table 5 summarizes the largest prospective study of pregnancy outcome in women on MTX prior to conception.40 It is also the only study where low-dose MTX was used within 1 year of pregnancy. A high rate of spontaneous abortion is seen (as mentioned above), but there were no abnormalities of surviving fetuses. However, the numbers (nine in total) are small. A study looked at 368 pregnancies in 210 women who had had single- and combined-agent chemotherapy for gestational trophoblastic tumours over a 20-year period. All patients were given MTX, followed in the majority by folinic acid. The mean duration between cessation of treatment and pregnancy was 2.7 years, the mean cumulative dose of MTX around 1.2 g, and the maximum dose over 6 g. Abnormalities included two anencephalic stillbirths, and one case each of spina bifida, tetralogy of Fallot, talipes equinovarus, collapsed lung and umbilical hernia. One child of a mother who had received MTX developed desquamative fibrosing alveolitis 1 month after birth. The mother later gave birth to a healthy child, but 3 years later, a further child suffered the same problem. In the study overall, there was a slightly higher but statistically insignificant incidence of stillbirth and congenital abnormality compared to the expected background rate.50 In an earlier report of a smaller number of patients, presumably from the same sample, the authors describe four cases of abnormality in 130 women who had received MTX alone. The abnormalities were: umbilical hernia, doliocephaly plus talipes, anencephaly and fibrosing alveolitis. Again, the fetal wastage rate was not raised.51 These authors, from an oncology unit, advise delaying conception for a year after the cessation of chemotherapy. This advice differs from manufacturer's recommended 'washout period' before MTX cessation and conception, which varies between 3 and 6 months.52 In order to allow for the persistence of MTX in tissues and to avoid potential chromosomal damage to the dividing follicle, a minimum delay of 6 months would seem logical." Jayne Charlamb, MD Syracuse *********************************************** To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or digest) To unsubscribe: unsubscribe lactnet All commands go to [log in to unmask] The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(R) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html