Methotrexate Use in a Breastfeeding Patient with Rheumatoid Arthritis
Bibliographic record
Abstract
To the Editor: Methotrexate (MTX), a folic acid antagonist, is considered the first-line treatment in the management of rheumatoid arthritis (RA)1. As a result of embryotoxic and teratogenic effects, MTX is discontinued in women planning to conceive2,3,4. RA disease activity often decreases during pregnancy and increases after delivery5. Thus, women with RA are monitored closely following delivery. Breastfeeding may also pose challenges, attributable to the concern about drug exposure for the infant and potential drug-related adverse effects. The American Academy of Pediatrics and other reviews recommend the avoidance of MTX in breastfeeding women3,4,6. There is limited evidence of mammary excretion of MTX. One case report from 1972 describes MTX milk levels in a 25-year-old lactating mother with choriocarcinoma being treated with oral MTX at a dose of 22.5 mg per day7. Milk, blood, and urine samples were obtained at 2-h intervals on the first day of treatment and MTX levels were assessed using a bioassay … Address correspondence to Dr. T. Nadarajah, University of Toronto, Medicine, 500 University Ave., Suite 602, Toronto, Ontario M5G 1V7, Canada. E-mail: thanu.nadarajah{at}gmail.com
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.003 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".