Baker Teresa, Datta Palika, Rewers-Felkins Kathleen, Hale Thomas W
1 Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center , Amarillo, Texas.
2 Department of Pediatrics, Texas Tech University Health Sciences Center , Amarillo, Texas.
Breastfeed Med. 2018 Jul/Aug;13(6):450-452. doi: 10.1089/bfm.2018.0078. Epub 2018 Jul 9.
Morbidly placenta accreta as a cause of postpartum morbidity is increasing in incidence. One conservative option is use of methotrexate as an adjuvant therapy for the management of placenta accreta. There is concern that use of methotrexate in a lactating mother could potentially expose her neonate to harmful effects of this medication.
Here we report a 29-year-old woman subjected to methotrexate treatment for placenta accreta. Her child was delivered at 32 weeks weighing 3 lbs. On postpartum day 5, this patient was diagnosed with placenta accreta and treated with intramuscular methotrexate for 3 consecutive days. She received 92 mg methotrexate intramuscularly daily, and was advised not to breastfeed. She collected milk samples on day 2, the 0 hour before the second dose and at 1, 2, 4, 8, 12, and 24 hours after taking the dose. A high-performance liquid chromatography mass spectrometry method was developed to measure methotrexate and its metabolite 7-hydroxymethotrexate levels in milk samples.
Very low levels were found for both methotrexate and 7-hydroxymethotrexate in the milk samples obtained. The results indicate that methotrexate or its metabolite receded to minimum concentration over a period of 24 hours.
This case report found the relative infant dose of methotrexate to be 0.11%. Methotrexate does transfer into breast milk, although the levels detected were very low. However, caution should still be used in counseling mothers regarding breastfeeding with this toxic drug.
作为产后发病原因的凶险性胎盘植入发病率正在上升。一种保守的选择是使用甲氨蝶呤作为胎盘植入管理的辅助治疗。人们担心在哺乳期母亲中使用甲氨蝶呤可能会使其新生儿接触到这种药物的有害影响。
在此，我们报告一名29岁因胎盘植入接受甲氨蝶呤治疗的女性。她的孩子在32周时出生，体重3磅。产后第5天，该患者被诊断为胎盘植入，并连续3天接受肌肉注射甲氨蝶呤治疗。她每天肌肉注射92毫克甲氨蝶呤，并被告知不要母乳喂养。她在第2天、第二次给药前0小时以及给药后1、2、4、8、12和24小时采集了乳汁样本。开发了一种高效液相色谱质谱法来测量乳汁样本中甲氨蝶呤及其代谢物7-羟基甲氨蝶呤的水平。
在所获得的乳汁样本中，甲氨蝶呤和7-羟基甲氨蝶呤的含量都非常低。结果表明，甲氨蝶呤及其代谢物在24小时内降至最低浓度。
本病例报告发现甲氨蝶呤的相对婴儿剂量为0.11%。甲氨蝶呤确实会转移到母乳中，尽管检测到的水平非常低。然而，在就使用这种有毒药物进行母乳喂养向母亲提供咨询时仍应谨慎。
