Developmental delay in fetal aminopterin methotrexate syndrome

Maternal exposures to aminopterin and methotrexate have been associated wit h a pattern of malformation which includes prenatal-onset growth deficiency , severe lack of ossification of the calvarium, hypoplastic supraorbital ri dges, small, low-set ears, micrognathia, and limb abnormalities. We report on a patient whose mother received methotrexate during the first trimester of pregnancy and who, in addition to the structural anomalies typical of ma ternal methotrexate exposure, has significant developmental delay. This is the third patient exposed to folic acid antagonists with mental retardation , providing further evidence that developmental delay is one feature of fet al aminopterin-methotrexate syndrome. Therefore, it is recommended that for mal developmental testing be performed in all patients prenatally exposed t o methotrexate. (C) 1999 Wiley-Liss, Inc.