Cleft palate and toe malformations in a child with fetal methotrexate exposure

Methotrexate, a commonly administered chemotherapeutic agent, is a well-known human teratogen. Exposure of a fetus between 6 and 8 weeks of gestation is postulated to cause birth defects. However, fetal exposure to this drug after this critical period is thought to have little to no effect on eventual fetal development and growth. The authors report a case of an infant whose mother was exposed to methotrexate during pregnancy. The infant was evaluated at their clinic for an incomplete cleft palate and associated asymmetric deformities of the toes on both feet.